Spine · 2024
Comparison of Length of Stay and Discharge Disposition After Short-Segment Lumbar Fusion Surgery at Tertiary Care and Nontertiary Care Hospitals: A Propensity Score-Matched Analysis.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Narayanan Rajkishen, Opara Olivia A, Kohring Adam, Lee Yunsoo, Carey Preston, Diejomaoh Rioke M, McCall Cordero, Lowitz Sean, Takagi-Stewart Julian, Bradley Evan, Kurd Mark F, Kaye Ian D, Mangan John J, Canseco Jose A, Hilibrand Alan S, Vaccaro Alexander R, Kepler Christopher K, Schroeder Gregory D
Аннотация
STUDY DESIGN: A retrospective study.
OBJECTIVE: To compare the perioperative and postoperative outcomes among lumbar fusion patients treated at an orthopedic specialty hospital (OSH), a hybrid community hospital (HCH), and a conventional community hospital in comparison to a tertiary care hospital (TCH).
SUMMARY OF BACKGROUND DATA: In spine surgery, strategies to reduce length of stay (LOS) include a myriad of pre-, intra-, and postoperative strategies that require a multidisciplinary infrastructure. The sum of these efforts has led to the creation of orthopedic specialty hospitals and protocols that have been adopted by community hospitals as well. There is a notable lack of information regarding the results of these efforts across different healthcare institution models.
METHODS: This was a retrospective study of patients undergoing elective one or two-level lumbar fusion between 2017 and 2022 at a large urban TCH, an OSH, a HCH, and a conventional CH. Data were collected on patient characteristics, demographics, comorbidities, BMI, smoking status, surgical type, surgical levels, surgery duration, hospital length of stay, readmissions, reoperations, and discharge status within a year. Patients across the four surgical settings were matched based on age, BMI, CCI, type of procedure, and number of levels fused.
RESULTS: A total of 1435 patients met the inclusion criteria. Length of hospital stay was significantly longer at TCH compared with OSH, HCH, and CH by an average of 1 to 2 days ( P <0.001). Ninety-day readmissions were higher at TCH compared with OSH ( P =0.001). TCH patients also were less likely to be discharged home than OSH and HCH patients ( P =0.001 and P =0.016, respectively). No significant differences were noted in 1-year reoperation rates across all hospital models.
CONCLUSIONS: Shorter lengths of stays and more home discharges at the orthopedic specialty hospital and community hospital settings did not compromise surgical quality or postoperative outcomes.
LEVEL OF EVIDENCE: Level III.
OBJECTIVE: To compare the perioperative and postoperative outcomes among lumbar fusion patients treated at an orthopedic specialty hospital (OSH), a hybrid community hospital (HCH), and a conventional community hospital in comparison to a tertiary care hospital (TCH).
SUMMARY OF BACKGROUND DATA: In spine surgery, strategies to reduce length of stay (LOS) include a myriad of pre-, intra-, and postoperative strategies that require a multidisciplinary infrastructure. The sum of these efforts has led to the creation of orthopedic specialty hospitals and protocols that have been adopted by community hospitals as well. There is a notable lack of information regarding the results of these efforts across different healthcare institution models.
METHODS: This was a retrospective study of patients undergoing elective one or two-level lumbar fusion between 2017 and 2022 at a large urban TCH, an OSH, a HCH, and a conventional CH. Data were collected on patient characteristics, demographics, comorbidities, BMI, smoking status, surgical type, surgical levels, surgery duration, hospital length of stay, readmissions, reoperations, and discharge status within a year. Patients across the four surgical settings were matched based on age, BMI, CCI, type of procedure, and number of levels fused.
RESULTS: A total of 1435 patients met the inclusion criteria. Length of hospital stay was significantly longer at TCH compared with OSH, HCH, and CH by an average of 1 to 2 days ( P <0.001). Ninety-day readmissions were higher at TCH compared with OSH ( P =0.001). TCH patients also were less likely to be discharged home than OSH and HCH patients ( P =0.001 and P =0.016, respectively). No significant differences were noted in 1-year reoperation rates across all hospital models.
CONCLUSIONS: Shorter lengths of stays and more home discharges at the orthopedic specialty hospital and community hospital settings did not compromise surgical quality or postoperative outcomes.
LEVEL OF EVIDENCE: Level III.