Medicaid payer status and other factors associated with hospital length of stay in patients undergoing primary lumbar spine surgery

OBJECTIVEHospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys, completed by patients following an inpatient stay, are utilized to assess patient satisfaction and quality of the patient experience. HCAHPS results directly impact hospital and provider reimbursements. While recent work has demonstrated that pre- and postoperative factors can affect HCAHPS results following lumbar spine surgery, little is known about how these results are influenced by hospital length of stay (LOS). Here, the authors examined HCAHPS results in patients with LOSs greater or less than expected following lumbar spine surgery to determine whether LOS influences survey scores after these procedures.METHODSThe authors conducted a retrospective review of HCAHPS surveys, patient demographics, and outcomes following lumbar spine surgery at a single institution. A total of 391 patients who had undergone lumbar spine surgery and had completed an HCAHPS survey in the period between 2013 and 2015 were included in this analysis. Patients were divided into those with a hospital LOS equal to or less than the expected (LTE-LOS) and those with a hospital LOS longer than expected (GTE-LOS). Expected LOS was based on the University HealthSystem Consortium benchmarks. Nineteen questions from the HCAHPS survey were examined in relation to patient LOS. The primary outcome measure was a comparison of “top-box” (“9–10” or “always or usually”) versus “low-box” (“1–8” and “somewhat or never”) scores on the HCAHPS questions. Secondary outcomes of interest were whether the comorbid conditions of cancer, chronic renal failure, diabetes, coronary artery disease, hypertension, stroke, or depression occurred differently with respect to LOS. Statistical analysis was performed using Fisher’s exact test for the 2 × 2 contingency tables and the chi-square test for categorical variables.RESULTSTwo hundred fifty-seven patients had an LTE-LOS, whereas 134 patients had a GTE-LOS. The only statistically significant difference in preoperative characteristics between the patient groups was hypertension, which correlated to a shorter LOS. A GTE-LOS was associated with a decreased likelihood of a top-box score for the HCAHPS survey items on doctor listening and pain control.CONCLUSIONSHere, the authors report a decreased likelihood of top-box responses for some HCAHPS questions following lumbar spine surgery if LOS is prolonged. This study highlights the need to further examine the factors impacting LOS, identify patients at risk for long hospital stays, and improve mechanisms to increase the quality and efficiency of care delivered to this patient population.

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Predictors of extended length of stay, discharge to inpatient rehab, and hospital readmission following elective lumbar spine surgery: introduction of the Carolina-Semmes Grading Scale

Journal of Neurosurgery Spine ◽

10.3171/2016.12.spine16928 ◽

2017 ◽

Vol 27 (4) ◽

pp. 382-390 ◽

Cited By ~ 32

Author(s):

Matthew J. McGirt ◽

Scott L. Parker ◽

Silky Chotai ◽

Deborah Pfortmiller ◽

Jeffrey M. Sorenson ◽

...

Keyword(s):

Lumbar Spine ◽

Length Of Stay ◽

Spine Surgery ◽

Hospital Readmission ◽

Inpatient Rehabilitation ◽

Lumbar Spine Surgery ◽

Day Hospital ◽

Data Set ◽

Inpatient Facility ◽

Grading Scale

OBJECTIVEExtended hospital length of stay (LOS), unplanned hospital readmission, and need for inpatient rehabilitation after elective spine surgery contribute significantly to the variation in surgical health care costs. As novel payment models shift the risk of cost overruns from payers to providers, understanding patient-level risk of LOS, readmission, and inpatient rehabilitation is critical. The authors set out to develop a grading scale that effectively stratifies risk of these costly events after elective surgery for degenerative lumbar pathologies.METHODSThe Quality and Outcomes Database (QOD) registry prospectively enrolls patients undergoing surgery for degenerative lumbar spine disease. This registry was queried for patients who had undergone elective 1- to 3-level lumbar surgery for degenerative spine pathology. The association between preoperative patient variables and extended postoperative hospital LOS (LOS ≥ 7 days), discharge status (inpatient facility vs home), and 90-day hospital readmission was assessed using stepwise multivariate logistic regression. The Carolina-Semmes grading scale was constructed using the independent predictors for LOS (0–12 points), discharge to inpatient facility (0–18 points), and 90-day readmission (0–6 points), and its performance was assessed using the QOD data set. The performance of the grading scale was then confirmed separately after using it in 2 separate neurosurgery practice sites (Carolina Neurosurgery & Spine Associates [CNSA] and Semmes Murphey Clinic).RESULTSA total of 6921 patients were analyzed. Overall, 290 (4.2%) patients required extended LOS, 654 (9.4%) required inpatient facility care/rehabilitation on hospital discharge, and 474 (6.8%) were readmitted to the hospital within 90 days postdischarge. Variables that remained as independently associated with these unplanned events in multivariate analysis included age ≥ 70 years, American Society of Anesthesiologists Physical Classification System class > III, Oswestry Disability Index score ≥ 70, diabetes, Medicare/Medicaid, nonindependent ambulation, and fusion. Increasing point totals in the Carolina-Semmes scale effectively stratified the incidence of extended LOS, discharge to facility, and readmission in a stepwise fashion in both the aggregate QOD data set and when subsequently applied to the CNSA/Semmes Murphey practice groups.CONCLUSIONSThe authors introduce the Carolina-Semmes grading scale that effectively stratifies the risk of prolonged hospital stay, need for postdischarge inpatient facility care, and 90-day hospital readmission for patients undergoing first-time elective 1- to 3-level degenerative lumbar spine surgery. This grading scale may be helpful in identifying patients who may require additional resource utilization within a global period after surgery.

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Impact of Frailty on Outcomes Following Spine Surgery: A Prospective Cohort Analysis of 668 Patients

Neurosurgery ◽

10.1093/neuros/nyaa468 ◽

2020 ◽

Author(s):

Nitin Agarwal ◽

Ezequiel Goldschmidt ◽

Tavis Taylor ◽

Souvik Roy ◽

Stefanie C Altieri Dunn ◽

...

Keyword(s):

Length Of Stay ◽

Spine Surgery ◽

Cohort Analysis ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Quality Improvement Initiative ◽

Exact Test ◽

Frail Patients ◽

Increased Risk ◽

Venous Thromboembolic

Abstract BACKGROUND With an aging population, elderly patients with multiple comorbidities are more frequently undergoing spine surgery and may be at increased risk for complications. Objective measurement of frailty may predict the incidence of postoperative adverse events. OBJECTIVE To investigate the associations between preoperative frailty and postoperative spine surgery outcomes including mortality, length of stay, readmission, surgical site infection, and venous thromboembolic disease. METHODS As part of a system-wide quality improvement initiative, frailty assessment was added to the routine assessment of patients considering spine surgery beginning in July 2016. Frailty was assessed with the Risk Analysis Index (RAI), and patients were categorized as nonfrail (RAI 0-29) or prefrail/frail (RAI ≥ 30). Comparisons between nonfrail and prefrail/frail patients were analyzed using Fisher's exact test for categorical data or by Wilcoxon rank sum tests for continuous data. RESULTS From August 2016 through September 2018, 668 patients (age of 59.5 ± 13.3 yr) had a preoperative RAI score recorded and underwent scheduled spine surgery. Prefrail and frail patients suffered comparatively higher rates of mortality at 90 d (1.9% vs 0.2%, P < .05) and 1 yr (5.1% vs 1.2%, P < .01) from the procedure date. They also had longer in-hospital length of stay (LOS) (3.9 d ± 3.6 vs 3.1 d ± 2.8, P < .001) and higher rates of 60 d (14.6% vs 8.2%, P < .05) and 90 d (15.8% vs 9.8%, P < .05) readmissions. CONCLUSION Preoperative frailty, as measured by the RAI, was associated with an increased risk of readmission and 90-d and 1-yr mortality following spine surgery. The RAI can be used to stratify spine patients and inform preoperative surgical decision making.

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Perioperative Factors Associated with Prolonged Intensive Care Unit and Hospital Length of Stay after Pediatric Neurosurgery

Pediatric Neurosurgery ◽

10.1159/000339312 ◽

2011 ◽

Vol 47 (6) ◽

pp. 423-429 ◽

Cited By ~ 5

Author(s):

Eduardo Mekitarian Filho ◽

Werther Brunow de Carvalho ◽

Sérgio Cavalheiro ◽

Nelson Kazunobu Horigoshi ◽

Norberto Antonio Freddi

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Length Of Stay ◽

Pediatric Neurosurgery ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Factors Associated

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FACTORS ASSOCIATED WITH INPATIENT ENDOSCOPY DELAY AND ITS IMPACT ON HOSPITAL LENGTH-OF-STAY AND 30-DAY READMISSION

Clinical Gastroenterology and Hepatology ◽

10.1016/j.cgh.2021.06.009 ◽

2021 ◽

Author(s):

Chelsea C. Jacobs ◽

Johnny F. Jaber ◽

Michael Ladna ◽

Sandeep Ponniah ◽

Ishaan Madhok ◽

...

Keyword(s):

Length Of Stay ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Factors Associated

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Variations in 30-day readmissions and length of stay among spine surgeons: a national study of elective spine surgery among US Medicare beneficiaries

Journal of Neurosurgery Spine ◽

10.3171/2018.1.spine171064 ◽

2018 ◽

Vol 29 (3) ◽

pp. 286-291 ◽

Cited By ~ 8

Author(s):

Siddhartha Singh ◽

Rodney Sparapani ◽

Marjorie C. Wang

Keyword(s):

Lumbar Spine ◽

Length Of Stay ◽

Spine Surgery ◽

Practice Patterns ◽

Lumbar Spine Surgery ◽

Medicare Beneficiaries ◽

Readmission Rates ◽

Underlying Assumption ◽

The Mean ◽

Hospital Characteristics

OBJECTIVEPay-for-performance programs are targeting hospital readmissions. These programs have an underlying assumption that readmissions are due to provider practice patterns that can be modified by a reduction in reimbursement. However, there are limited data to support the role of providers in influencing readmissions. To study this, the authors examined variations in readmission rates by spine surgeon within 30 days among Medicare beneficiaries undergoing elective lumbar spine surgery for degenerative conditions.METHODSThe authors applied validated ICD-9-CM algorithms to 2003–2007 Medicare data to select beneficiaries undergoing elective inpatient lumbar spine surgery for degenerative conditions. Mixed models, adjusting for patient demographics, comorbidities, and surgery type, were used to estimate risk of 30-day readmission by the surgeon. Length of stay (LOS) was also studied using these same models.RESULTSA total of 39,884 beneficiaries were operated on by 3987 spine surgeons. The mean readmission rate was 7.2%. The mean LOS was 3.1 days. After adjusting for patient characteristics and surgery type, 1 surgeon had readmission rates significantly below the mean, and only 5 surgeons had readmission rates significantly above the mean. In contrast, for LOS, the patients of 288 surgeons (7.2%) had LOS significantly lower than the mean, and the patients of 397 surgeons (10.0%) had LOS significantly above the mean. These findings were robust to adjustments for surgeon characteristics and clustering by hospital. Similarly, hospital characteristics were not significantly associated with readmission rates, but LOS was associated with hospital for-profit status and size.CONCLUSIONSThe authors found almost no variations in readmission rates by surgeon. These findings suggest that surgeon practice patterns do not affect the risk of readmission. Likewise, no significant variation in readmission rates by hospital characteristics were found. Strategies to reduce readmissions would be better targeted at factors other than providers.

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