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.

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.