Is Length of Stay Influenced by the Weekday On Which Lumbar Surgery is Performed?

Neurosurgery ◽  
2018 ◽  
Vol 85 (4) ◽  
pp. 494-499 ◽  
Author(s):  
Ahilan Sivaganesan ◽  
Clinton J Devin ◽  
Inamullah Khan ◽  
Panagiotis Kerezoudis ◽  
Hui Nian ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Length Of Stay ◽  
Cost Savings ◽  
Lumbar Spine Surgery ◽  
Nursing Facilities ◽  
Lumbar Surgery ◽  
Lumbar Degenerative Disease ◽  
Patient Disposition ◽  
Quality And Outcomes ◽  
Day Of The Week

Abstract BACKGROUND Reducing length of stay (LOS) in a safe manner has the potential to save significant costs for the care of patients undergoing elective lumbar spine surgery. Due to the relative absence on weekends of staff required for discharging patients to rehabilitation or nursing facilities, we hypothesize that patients undergoing lumbar surgery later in the week have a longer LOS than their counterparts. OBJECTIVE To analyze the effect of day of the week for lumbar surgery on LOS. METHODS Patients undergoing surgery for lumbar degenerative disease were prospectively enrolled in the multicenter quality and outcomes database registry. A multivariable proportional odds regression model was built with LOS as the outcome of interest and patient and surgical variables as covariates. RESULTS A total of 11 897 patients were analyzed. Among those discharged home, the regression analysis demonstrated significantly higher odds of longer LOS for patients undergoing surgery on Friday as compared to Monday (P < .001). Among those discharged to a facility, there were significantly higher odds of longer LOS for patients undergoing surgery on Wednesday (P < .001), Thursday (P < .001), and Friday (P = .002) as compared to Monday. CONCLUSION The findings of this study suggest that lumbar patients undergoing fusions and those discharged to a facility have longer LOS when surgery is later in the week. Scheduling these patients for surgery earlier in the week and ensuring adequate resources for patient disposition on weekends may lead to LOS reduction and cost savings for hospitals, payers, and patients alike.

Ambulation on Postoperative Day #0 Is Associated With Decreased Morbidity and Adverse Events After Elective Lumbar Spine Surgery: Analysis From the Michigan Spine Surgery Improvement Collaborative (MSSIC)

Neurosurgery ◽  
2019 ◽  
Vol 87 (2) ◽  
pp. 320-328 ◽  
Author(s):  
Hesham Mostafa Zakaria ◽  
Michael Bazydlo ◽  
Lonni Schultz ◽  
Muwaffak Abdulhak ◽  
David R Nerenz ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Adverse Events ◽  
Spine Surgery ◽  
Postoperative Care ◽  
Enhanced Recovery ◽  
Cost Savings ◽  
Lumbar Spine Surgery ◽  
Lumbar Surgery ◽  
Single Level ◽  
Vein Thrombosis

Abstract BACKGROUND While consistently recommended, the significance of early ambulation after surgery has not been definitively studied. OBJECTIVE To identify the relationship between ambulation on the day of surgery (postoperative day (POD)#0) and 90-d adverse events after lumbar surgery. METHODS The Michigan Spine Surgery Improvement Collaborative (MSSIC) is a prospective multicenter registry of spine surgery patients. As part of routine postoperative care, patients either ambulated on POD#0 or did not. The 90-d adverse events of length of stay (LOS), urinary retention (UR), urinary tract infection (UTI), ileus, readmission, surgical site infection (SSI), pulmonary embolism/deep vein thrombosis (PE/DVT), and disposition to a rehab facility were measured. RESULTS A total of 23 295 lumbar surgery patients were analyzed. POD#0 ambulation was associated with decreased LOS (relative LOS 0.83, P &lt; .001), rehab discharge (odds ratio [OR] 0.52, P &lt; .001), 30-d (OR 0.85, P = .044) and 90-d (OR 0.86, P = .014) readmission, UR (OR 0.73, P = 10), UTI (OR 73, P = .001), and ileus (OR 0.52, P &lt; .001) for all patients. Significant improvements in LOS, rehab discharge, readmission, UR, UTI, and ileus were observed in subset analysis of single-level decompressions (4698 pts), multilevel decompressions (4079 pts), single-level fusions (4846 pts), and multilevel fusions (4413 pts). No change in rate of SSI or DVT/PE was observed for patients who ambulated POD#0. CONCLUSION POD#0 ambulation is associated with a significantly decreased risk for several key adverse events after lumbar spine surgery. Decreasing the incidence of these outcomes would be associated with significant cost savings. As ambulation POD#0 is a modifiable factor in any patient's postoperative care following most spine surgery, it should be encouraged and incorporated into spine-related, enhanced-recovery-after-surgery programs.

scholarly journals Ambulation on POD#0 Is Associated With Decreased Adverse Events After Elective Lumbar Spine Surgery: Analysis of the Michigan Spine Surgery Improvement Collaborative (MSSIC)

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Hesham M Zakaria ◽  
Rachel J Hunt ◽  
Theresa A Elder ◽  
Michael Bazydlo ◽  
Lonni Schultz ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Adverse Events ◽  
Spine Surgery ◽  
Enhanced Recovery ◽  
Cost Savings ◽  
Lumbar Spine Surgery ◽  
Lumbar Surgery ◽  
Single Level ◽  
Patient Variables ◽  
Multilevel Fusion

Abstract INTRODUCTION The Michigan Spine Surgery Improvement Collaborative (MSSIC) is a multicenter quality-improvement collaborative. Using MSSIC, we sought to identify the relationship between ambulation on the day of surgery (POD#0) and 90-d adverse events after lumbar surgery, specifically length of stay (LOS), urinary retention (UR), urinary tract infection (UTI), ileus, readmission, surgical site infection (SSI), PE/DVT, and disposition to a rehab facility. METHODS In 23295 lumbar surgery patients, matching was performed to ensure overlap on patient variables. Generalized estimating equations (GEE) models were run on the matched dataset to further account for patient demographics, medical history, and surgical intensity. RESULTS POD#0 ambulation was associated with decreased LOS (OR 0.83, P < .001), UR (OR 0.73, P = .008), UTI (OR 0.52, P = .001), ileus (OR 0.52, P < .001), 30-d (OR 0.84, P = .035) and 90-d (OR 0.86, P = .009) readmission, and rehab discharge (OR 0.52, P < .001) for all patients. POD#0 ambulation after single-level decompression (6244 patients) decreased LOS (OR 0.72, P < .001), UR (OR 0.73, P = .004), UTI (OR 0.43, P = .003), and rehab discharge (OR 0.18, P < .001). Ambulation after multilevel decompression (5526 patients) was associated with decreased LOS (OR 0.73, P < .001), UR (OR 0.75, P = .04), ileus (OR 0.60, P = .027), and rehab discharge (OR 0.44, P < .001). Ambulation after single-level fusion (5790 patients) decreased LOS (OR 0.85, P < .001), 30-d readmission (OR 0.77, P = .032), and rehab discharge (OR 0.65, P = .004). Ambulation after multilevel fusion (5735 patients) decreased LOS (OR 0.88, P < .001), UTI (OR 0.60, P = .003), ileus (OR 0.51, P = .02), 30-d readmission (OR 0.77, P = .032), and rehab discharge (OR 0.59, P < .001). No change in rate of or DVT/PE was observed for patients who ambulated POD#0. CONCLUSION POD#0 ambulation is associated with a significantly decreased risk for several key adverse events after lumbar spine surgery. Decreasing the incidence of these outcomes would be associated with significant cost savings. As ambulation POD#0 is a modifiable factor in any patient's postoperative care following most spine surgery, it should be encouraged and incorporated into spine-related enhanced recovery after surgery (ERAS) programs.

scholarly journals Surgical Comanagement by Hospitalists: Continued Improvement Over 5 Years

2020 ◽  
pp. 232-235
Author(s):  
Nidhi Rohatgi ◽  
Yingjie Weng ◽  
Neera Ahuja
Keyword(s):  
Internal Medicine ◽  
Regression Analysis ◽  
Length Of Stay ◽  
Patient Outcomes ◽  
Cost Savings ◽  
Rapid Response Team ◽  
Medical Complication ◽  
Surgical Services ◽  
Response Team ◽  
Yearly Change

Neurosurgery services in which the same Internal Medicine hospitalists are dedicated year round to each of these surgical services to proactively prevent and manage medical conditions. In this article, we evaluate if SCM was associated with continued improvement in patient outcomes between 2012 and 2018 in Orthopedic and Neurosurgery services at our institution. We conducted regression analysis on 26,380 discharges to assess yearly change in our outcomes. Since 2012, the odds of patients with ≥1 medical complication decreased by 3.8% per year (P = .01), the estimated length of stay decreased by 0.3 days per year (P < .0001), and the odds of rapid response team calls decreased by 12.2% per year (P = .001). Estimated average direct cost savings were $3,424 per discharge.

Admission day of the week impacts GI length of stay and charges

2001 ◽  
Vol 120 (5) ◽  
pp. A403-A404
Author(s):  
J HARRISON ◽  
J ROTH ◽  
R COHEN
Keyword(s):  
Length Of Stay ◽  
Day Of The Week

Impact That Day of the Week has on Length of Stay for Video-assisted Lobectomy

2020 ◽  
Author(s):  
Stevan S. Pupovac ◽  
Paul C. Lee ◽  
Julissa Jurado ◽  
Kevin Hyman ◽  
Larry Glassman ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Video Assisted ◽  
Day Of The Week

scholarly journals Differences in Hospital Costs among Octogenarians and Nonagenarians Following Primary Total Joint Arthroplasty

Geriatrics ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. 26
Author(s):  
Christopher Fang ◽  
Andrew Hagar ◽  
Matthew Gordon ◽  
Carl T. Talmo ◽  
David A. Mattingly ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Total Joint Arthroplasty ◽  
Hospital Costs ◽  
Cost Effective ◽  
Joint Arthroplasty ◽  
Nursing Facilities ◽  
Activity Based Costing ◽  
Skilled Nursing ◽  
Value Based Care ◽  
Hospital Expenses

The proportion of patients over the age of 90 years continues to grow, and the anticipated demand for total joint arthroplasty (TJA) in this population is expected to rise concomitantly. As the country shifts to alternative reimbursement models, data regarding hospital expenses is needed for accurate risk-adjusted stratification. The aim of this study was to compare total in-hospital costs following primary TJA in octogenarians and nonagenarians, and to determine the primary drivers of cost. This was a retrospective analysis from a single institution in the U.S. We used time-drive activity-based costing (TDABC) to capture granular total hospital costs for each patient. 889 TJA’s were included in the study, with 841 octogenarians and 48 nonagenarians. Nonagenarians were more likely to undergo total hip arthroplasty (THA) (70.8% vs. 42.4%; p < 0.0001), had higher ASA classification (2.6 vs. 2.4; p = 0.049), and were more often privately insured (35.4% vs. 27.8%; p = 0.0001) as compared to octogenarians. Nonagenarians were more often discharged to skilled nursing facilities (56.2% vs. 37.5%; p = 0.0011), experienced longer operating room (OR) time (142 vs. 133; p = 0.0201) and length of stay (3.7 vs. 3.1; p = 0.0003), and had higher implant and total in-hospital costs (p < 0.0001 and 0.0001). Multivariate linear regression showed implant cost (0.700; p < 0.0001), length of stay (0.546; p < 0.0001), and OR time (0.288; p < 0.0001) to be the strongest associations with overall costs. Primary TJA for nonagenarians was more expensive than octogenarians. Targeting implant costs, length of stay, and OR time can reduce costs for nonagenarians in order to provide cost-effective value-based care.

scholarly journals Adoption of Enhanced Surgical Recovery (ESR) Protocol for Lumbar Fusion Decreases In-Hospital Postoperative Opioid Consumption

2021 ◽  
pp. 219256822110156
Author(s):  
Ehsan Jazini ◽  
Alexandra E. Thomson ◽  
Andre D. Sabet ◽  
Leah Y. Carreon ◽  
Rita Roy ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Length Of Stay ◽  
Transition Period ◽  
Urinary Catheter ◽  
Lumbar Fusion ◽  
Secondary Analysis ◽  
Opioid Consumption ◽  
Catheter Removal ◽  
Pain Scores ◽  
The Impact

Study Design: Retrospective observational cohort. Objectives: We sought to evaluate the impact of ESR on in-hospital and 90-day postoperative opioid consumption, length of stay, urinary catheter removal and postoperative ambulation after lumbar fusion for degenerative conditions. Methods: We evaluated patients undergoing lumbar fusion surgery at a single, multi-surgeon center in the transition period prior to (N = 174) and after (N = 116) adoption of ESR, comparing in-hospital and 90-day postoperative opioid consumption. Regression analysis was used to control for confounders. Secondary analysis was preformed to evaluate the association between ESR and length of stay, urinary catheter removal and ambulation after surgery. Results: Mean age study participants was 52.6 years with 62 (47%) females. Demographic characteristics were similar between the Pre-ESR and ESR groups. ESR patients had better 3-month pain scores, ambulated earlier, had urinary catheters removed earlier and decreased in-hospital opioid consumption compared to Pre-ESR patients. There was no difference in 90-day opioid consumption between the 2 groups. Regression analysis showed that ESR was strongly associated with in-hospital opioid consumption, accounting for 30% of the variability in Morphine Milligram Equivalents (MME). In-hospital opioid consumption was also associated with preoperative pain scores, number of surgical levels, and insurance type (private vs government). Pre-op pain sores were associated with 90-day opioid consumption. Secondary analysis showed that ESR was associated with a shorter length of stay and earlier ambulation. Conclusions: This study showed ESR has the potential to improve recovery after lumbar fusion for degenerative conditions with reduced in-hospital opioid consumption and improved postoperative pain scores.

scholarly journals Patient characteristics of smokers undergoing lumbar spine surgery: an analysis from the Quality Outcomes Database

2017 ◽  
Vol 27 (6) ◽  
pp. 661-669 ◽  
Author(s):  
Anthony L. Asher ◽  
Clinton J. Devin ◽  
Brandon McCutcheon ◽  
Silky Chotai ◽  
Kristin R. Archer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Lumbar Spine ◽  
Smoking Status ◽  
Patient Characteristics ◽  
Lumbar Spine Surgery ◽  
Multivariable Logistic Regression Analysis ◽  
Insurance Status ◽  
Quality Outcomes

OBJECTIVEIn this analysis the authors compare the characteristics of smokers to nonsmokers using demographic, socioeconomic, and comorbidity variables. They also investigate which of these characteristics are most strongly associated with smoking status. Finally, the authors investigate whether the association between known patient risk factors and disability outcome is differentially modified by patient smoking status for those who have undergone surgery for lumbar degeneration.METHODSA total of 7547 patients undergoing degenerative lumbar surgery were entered into a prospective multicenter registry (Quality Outcomes Database [QOD]). A retrospective analysis of the prospectively collected data was conducted. Patients were dichotomized as smokers (current smokers) and nonsmokers. Multivariable logistic regression analysis fitted for patient smoking status and subsequent measurement of variable importance was performed to identify the strongest patient characteristics associated with smoking status. Multivariable linear regression models fitted for 12-month Oswestry Disability Index (ODI) scores in subsets of smokers and nonsmokers was performed to investigate whether differential effects of risk factors by smoking status might be present.RESULTSIn total, 18% (n = 1365) of patients were smokers and 82% (n = 6182) were nonsmokers. In a multivariable logistic regression analysis, the factors significantly associated with patients’ smoking status were sex (p < 0.0001), age (p < 0.0001), body mass index (p < 0.0001), educational status (p < 0.0001), insurance status (p < 0.001), and employment/occupation (p = 0.0024). Patients with diabetes had lowers odds of being a smoker (p = 0.0008), while patients with coronary artery disease had greater odds of being a smoker (p = 0.044). Patients’ propensity for smoking was also significantly associated with higher American Society of Anesthesiologists (ASA) class (p < 0.0001), anterior-alone surgical approach (p = 0.018), greater number of levels (p = 0.0246), decompression only (p = 0.0001), and higher baseline ODI score (p < 0.0001). In a multivariable proportional odds logistic regression model, the adjusted odds ratio of risk factors and direction of improvement in 12-month ODI scores remained similar between the subsets of smokers and nonsmokers.CONCLUSIONSUsing a large, national, multiinstitutional registry, the authors described the profile of patients who undergo lumbar spine surgery and its association with their smoking status. Compared with nonsmokers, smokers were younger, male, nondiabetic, nonobese patients presenting with leg pain more so than back pain, with higher ASA classes, higher disability, less education, more likely to be unemployed, and with Medicaid/uninsured insurance status. Smoking status did not affect the association between these risk factors and 12-month ODI outcome, suggesting that interventions for modifiable risk factors are equally efficacious between smokers and nonsmokers.

scholarly journals Day Of The Week dan Monday Effect: Fenomena yang Terbuktikan Tidak Konsisten Di Pasar Modal Indonesia

2008 ◽  
Vol 1 (1) ◽  
Author(s):  
Sumiyana Sumiyana
Keyword(s):  
Regression Analysis ◽  
Stock Exchange ◽  
Short Interval ◽  
Return Periods ◽  
Trading Frequency ◽  
Monday Effect ◽  
Methodological Research ◽  
Intraday Data ◽  
Day Of The Week ◽  
Observation Period

This research critiques Sumiyana (2007a) that is actually weak methodological research design. Sumiyana (2007a) investigates trading and nontrading periods return only, or it doesn’t split intra-day return into short interval period. Although Sumiyana (2007a) found strongly the phenomenon of the Monday effect, but it could not capture the inside occurrence in the intra-trading periods. This study examines the day of the week and Monday effect phenomena in the Indonesian Stock Exchange using intraday data in every 30 minutes interval. Samples of the data are the firms listed in LQ45. Sequentially, samples are filtered to stocks that actively traded in the Indonesian Stock Exchange based on trading frequency in observation period from January to December 2006. This study uses regression analysis with multiple dummies constructed by separating trading periods in every day into 12 return periods. This research finds that day of the week phenomena occur consistently in Indonesian Stock Exchange, but the occurrence are not evenly in the same day. In addition, this study concludes that Monday effect exists partially and incidentally only.

Evaluation, Development, and Implementation of Potentially Better Practices in Neonatal Intensive Care Nutrition

PEDIATRICS ◽  
2003 ◽  
Vol 111 (Supplement_E1) ◽  
pp. e461-e470
Author(s):  
Barbara Kuzma-O’Reilly ◽  
Maria L. Duenas ◽  
Coleen Greecher ◽  
Lois Kimberlin ◽  
Dennis Mujsce ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Neonatal Intensive Care ◽  
Outcome Measure ◽  
Implementation Strategies ◽  
Cost Savings ◽  
Nutrition Support ◽  
Evidence Based ◽  
Published Evidence ◽  
Support Practices ◽  
Neonatal Population

Objective. The desire for evidence-based clinical guidelines for nutritional support of the preterm infant has been identified. Published evidence has not yielded clear guidelines about the best method of delivery, substrate use, or appropriate outcome measure to evaluate nutrition support. In addition, reports on research of nutrition support often fail to give the most rudimentary process necessary to improve quality in various unit settings. Methods. The Vermont Oxford Network “Got Milk” focus group developed eight potentially better practices for nutrition support, implementation strategies for these practices, and a comprehensive appraisal process to measure nutrition outcome in preterm infants. Results. After implementation of the potentially better practices, all participating institutions showed earlier initiation of nutrition support, earlier attainment of adequate energy intakes, reduced delay in reaching full enteral feeds, more consistent nutrition support practice, decreased length of stay, cost savings, and improved growth at time of discharge. Conclusions. Development and implementation of evidence-based better nutrition support practices in neonates led to improved nutrient intake and growth with reduced length of stay and related costs. Consistent, comprehensive, multidisciplinary appraisal of practice is an integral component of improving nutrition outcomes in the neonatal population.

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