Late Week Surgery Is Associated With Longer Length of Stay in Patients Undergoing Laminectomy for Degenerative Lumbar Stenosis
Abstract INTRODUCTION As episode-based payment initiatives are becoming more prevalent, it becomes critical for providers to reduce unnecessary costs. Prolonged length of stay (LOS) can be a major driver of cost following elective spine surgery. While prolonged LOS may be medically indicated, the present study sought to assess how an overlooked variable, the day of the week that the surgery was performed, may influence LOS. METHODS A retrospective review was performed for all patients undergoing level 1 to 2 laminectomy surgery for degenerative lumbar spinal stenosis within a single large healthcare system from March 1, 2016 to February 1, 2019. The weekday of surgery was classified as a binary variable: early (Monday/Tuesday) vs late week (Thursday/Friday). Multiple regression models were fit to assess the association of hospital LOS and weekday of surgery. Additional covariates such as primary insurer, surgery location, Elixhauser comorbidity score, postoperative complications, and discharge disposition were also included in candidate models. RESULTS A total of 1087 subjects fit the inclusion criteria and had a median LOS of 2 d (IQR: 1-3). The final model accounted for 53% of variation in LOS. Late week surgery was a significant predictor of longer LOS (12%, 95% CI: 5.5–20%) after controlling for other covariates. Additionally, late week surgery and discharge disposition demonstrated a significant interaction, where patients requiring a Skilled Nursing Facility/Inpatient Rehabilitation (SNF/Rehab) placement were predicted to have 32% longer LOS (95% CI: 9.1–60.2). Medicaid insurance, greater comorbidities, surgery at main campus, and postoperative complications were also significantly associated with longer LOS. CONCLUSION These results suggest that late-week surgery is associated with a significantly longer LOS compared to early-week surgery while holding other predictors constant. Since the increased LOS of late-week surgery is most pronounced for SNF/Rehab discharges, optimization of scheduling algorithms or presurgical authorization of SNF/Rehab based on SNF/Rehab risk may mitigate longer LOS and their associated expenditures.