The Effect of Acute Inpatient Rehabilitation on Functional Outcomes and Discharge Disposition Following Liver Transplant

Background: Patients undergoing liver transplantation often face many challenges with functional independence, which acute rehabilitation can assist them in overcoming. Due to increased yearly liver transplantations, further investigation is required to evaluate the efficiency of acute rehabilitation. The objective of this study is to analyze the efficacy of acute rehabilitation in patients who underwent liver transplantation, primarily using Functional Independence Measure (FIMTM) scores and discharge disposition. Methods: A retrospective chart review was conducted on 143 encounters, consisting of 107 patients who underwent liver transplantation. Inclusion factors consisted of undergoing liver transplantation between January 2014–December 2018, admission into acute rehabilitation within 6 months post-transplant, and the availability of admission date, admission FIMTM, duration of stay, discharge FIMTM, and discharge disposition. These factors were evaluated in this study. Results: Patients who underwent acute rehabilitation following liver transplantation were found to have statistically significant positive FIMTM change (P < 0.00001) and FIMTM efficiency (P < 0.00001). The mean FIMTM change and efficiency were 25.4±18.5 and 2.0±1.6, respectively, for patients meeting inclusion criteria, and 35.7±11.8 and 2.4±1.0, respectively, when return to acute care (RTAC) encounters were excluded. A positive correlation was found between longer duration of stay in acute rehabilitation and positive FIMTM change for all patients meeting inclusion criteria (P < 0.00001, r = 0.465), and excluding RTAC encounters (P < 0.00001, r = 0.393). 34.3% (n = 49) of encounters had an RTAC, 3.5% (n = 5) were discharged to a skilled nursing facility (SNF), and 62.2% (n = 89) were discharged to the community. Overall, 83.2% (n = 89) of patients ultimately had a community discharge. Infection, respiratory/CV complications, and gastrointestinal complications were the most common causes for RTAC. Conclusion: Acute rehabilitation provides patients who have received a liver transplant with the opportunity to significantly improve their function and independence.

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The effects of telehealth use for post-acute rehabilitation patient outcomes

Journal of Telemedicine and Telecare ◽

10.1177/1357633x16686771 ◽

2016 ◽

Vol 24 (3) ◽

pp. 179-184 ◽

Cited By ~ 2

Author(s):

Stephanie A Hicks ◽

Verena R Cimarolli

Keyword(s):

Cognitive Functioning ◽

Patient Outcomes ◽

Skilled Nursing Facility ◽

Functional Independence ◽

Emergency Department Visits ◽

Nursing Facility ◽

Skilled Nursing ◽

Rehabilitation Care ◽

Acute Rehabilitation ◽

The Impact

Introduction Previous research has shown that home telehealth services can reduce hospitalisations and emergency department visits and improve clinical outcomes among older adults with chronic conditions. However, there is a lack of research on the impact of telehealth (TH) use on patient outcomes in post-acute rehabilitation settings. The current study examined the effects of TH for post-acute rehabilitation patient outcomes (i.e. discharge setting and change in functional independence) when controlling for other factors (e.g. cognitive functioning). Methods For this retrospective study, electronic medical records (EMRs) of 294 patients who were discharged from a post-acute rehabilitation unit at a skilled nursing facility were reviewed. Only patients with an admitting condition of a circulatory disease based on ICD-9 classification were included. Main EMR data extracted included use of TH, cognitive functioning, admission and discharge functional independence, and discharge setting (returning home vs. returning to acute care/re-hospitalisation). Results Results from a regression analysis showed that although TH use was unrelated to post-acute rehabilitation care transition, it was significantly related to change in functional independence. Patients who used TH during their stay had significantly more improvement in functional independence from admission to discharge when compared to those who did not use TH. Discussion Findings indicate that TH use during post-acute rehabilitation has the potential to improve patient physical functioning.

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Severe Disability After Stroke: Outcome After Inpatient Rehabilitation

Neurorehabilitation and Neural Repair ◽

10.1177/154596839901300310 ◽

1999 ◽

Vol 13 (3) ◽

pp. 199-203 ◽

Cited By ~ 9

Author(s):

John G. Schmidt ◽

Jessie Drew-Cates ◽

Mary L. Dombovy

Keyword(s):

Functional Outcome ◽

Hemorrhagic Stroke ◽

Inpatient Rehabilitation ◽

Functional Independence ◽

Efficiency Score ◽

Poor Functional Outcome ◽

Rehabilitation Unit ◽

Home Setting ◽

Severe Stroke ◽

Acute Rehabilitation

Objective: To determine the functional outcome following acute rehabilitation of patients with severe and very severe stroke using the Functional Independence Mea sure (FIM). Background: Most patients with severe and very severe stroke are reported in the literature to have a poor functional outcome. However, there are few studies that specifically address severity and their conclusions are confounding. Methods: We retrospectively reviewed charts of 41 consecutive patients with the primary diag nosis of ischemic or hemorrhagic stroke admitted to an inpatient rehabilitation unit with a admission FIM score of <60. Outcome measures included discharge residence, length of stay, and FIM score. Results: Over 63 percent (26 patients) were discharged to home. Discharge mean FIM scores (61.24) were significantly improved over the admission mean FIM (34.12) for self-care, mobility, communication, and social cog nition. The FIM Efficiency score was 0.356/day (mean[FIMdis-FIMadm]/mean LOS) as compared with previous reports of FIM Efficiency of 0.97/day for all stroke. Con clusion: Patients with severe stroke can experience improvement during inpatient rehabilitation and be discharged to a home setting, although the rate of improvement is less than that of more moderate stroke.

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Rehabilitation Outcomes in Subjects with West Nile Neuro-Invasive Disease

Brain Sciences ◽

10.3390/brainsci11101253 ◽

2021 ◽

Vol 11 (10) ◽

pp. 1253

Author(s):

Komal Patel ◽

Brian D. Greenwald ◽

Rosanna C. Sabini

Keyword(s):

Brain Injury ◽

Assisted Living ◽

Functional Decline ◽

Skilled Nursing Facility ◽

Functional Independence Measure ◽

Inpatient Rehabilitation ◽

The United States ◽

Functional Independence ◽

West Nile ◽

Rehabilitation Facility

West Nile Virus (WNV) is the most common mosquito borne cause of viral encephalitis in the United States. Physical and neuro-cognitive recovery from WNND may be prolonged or incomplete leading to chronic cognitive inefficiencies and functional decline. There continues to be no effective treatment of WNV and current management is primarily supportive. The objective of this review is to evaluate the functional outcomes and role of rehabilitation services in subjects with WNND. The charts of five subjects admitted to an acute inpatient brain injury rehabilitation facility from June to December 2012 were retrospectively reviewed. (Mean, Range)-Age (64.8, 43–78 years), Admission Functional Independence Measure (FIM) (45.2, 14–63), Discharge FIM (82.2, 61–100), FIM score gain (37, 24–60), Cognitive FIM gain (7, 1–18), Mobility FIM gain (17.4, 13–20), ADL FIM gain (12.6, 4–23); acute brain injury inpatient rehabilitation facility length of stay (LOS) (17.8, 14–21 days); acute hospital LOS (15, 10–22 days). Of the five subjects, three were discharged home, one was discharged to a skilled nursing facility, and one was discharged to an assisted living facility. Subjects with WNND have significant functional decline across all FIM subcategories and may benefit from a course of brain injury-specific acute inpatient rehabilitation.

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Abstract 124: Post-acute Care Disposition To Home Or Acute Rehabilitation Helps Determine Favorable Clinical Outcome In The SENTIS Trial.

Stroke ◽

10.1161/str.44.suppl_1.a124 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Samir R Belagaje ◽

Kay Zander ◽

Lisa Thackeray ◽

Rishi Gupta

Keyword(s):

Acute Stroke ◽

Acute Care ◽

Skilled Nursing Facility ◽

Inpatient Rehabilitation ◽

Favorable Outcome ◽

Stroke Severity ◽

Skilled Nursing ◽

Stroke Treatment ◽

Discharge Disposition ◽

Post Acute Care

Intro: A person with stroke has improved outcomes with post-acute care in an inpatient rehabilitation facility (IRF) or at home compared to those who are discharged to a skilled nursing facility (SNF). However, this research was conducted in an era before acute stroke treatment was fully developed and implemented. In this analysis of a recently completed acute intervention trial, we hypothesize that subjects with similar severity of strokes will have better 90 day outcomes if they are discharged to a IRF or home compared to a SNF. Methods: Using the data from SENTIS, a prospective, multi-center single-blind, randomized trial of use of NeuroFlo technology compared to standard acute stroke therapy, patient demographics, day 4 National Institutes of Health Stroke Scores (NIHSS), and 90 day modified Rankin scores (mRS) was obtained. Severity of stroke was classfied in 3 groups based on NIHSS: less than 8, 8-13, 14+. Disposition following acute hospital care was classified as home, IRF and SNF. A favorable outcome was defined as 90 day mRS ≤ 2. For each stroke severity class, the effect of each disposition on a favorable outcome was calculated. Results: A total of 292 patients were analyzed with a mean age of 65±14 with presenting NIHSS of < 8 in 94/297(31.6%), NIHSS 8-13 in 118/297(39.7%) and 14+ in 85/297(28.6%) of patients. Regardless of day 4 NIHSS, only 2 out of 28 (7.1%) patients who were discharged to SNF achieved a 90 day mRS ≤2, compared to 60/153 (39.2%) in the IRF group (OR 8.02 95%CI[1.83-35.11], p=0.0057). Table 1 shows the distribution of outcomes by post-acute care disposition and day 4 NIHSS. Conclusions: The day 4 NIHSS had an inverse relationship with the likelihood of a favorable outome. Subjects who were discharged home or to an IRF were significantly more likely to have a favorable outcome compared to those who were discharged to a SNF. This analysis supports prior data stating that discharge disposition plays a role in determining outcomes.

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Abstract P52: Absence of Dysphagia is a Stronger Predictor of Favorable Discharge Disposition than Stroke Severity: Insights from the UTHSC Houston Stroke Registry

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.4.suppl_1.ap52 ◽

2011 ◽

Vol 4 (suppl_1) ◽

Author(s):

Nneka I Jones ◽

Nusrat Harun ◽

Elizabeth Noser ◽

James Grotta

Keyword(s):

Skilled Nursing Facility ◽

Inpatient Rehabilitation ◽

Stroke Care ◽

Level Of Care ◽

Stroke Severity ◽

Nursing Facility ◽

Skilled Nursing ◽

Stroke Registry ◽

Post Stroke ◽

Discharge Disposition

Introduction: Dysphagia is one of the most common post-stroke complications. The use of feeding tubes to provide nutrition requires increased acuity of care for management, which affects costs. This care is provided at all levels, including Inpatient Rehabilitation (IR), Skilled Nursing Facility (SNF) or Sub-acute (Sub). There are limited studies of the role of dysphagia as a predictor of post-stroke disposition. Hypothesis: Low NIHSS is a predictor of higher function. We assessed the hypothesis that the absence of tube feeds as an indicator of dysphagia is a predictor of post-stroke disposition to a similar functional level. Methods: All patients admitted to the UT Stroke Service between January 2004 and October 2009 were included. Stratification occurred for age >65, NIHSS and stroke risk factors. Using multivariate logistic regression, the data was analyzed to determine if differences in post-stroke disposition were present among patients not receiving tube feeds as an indicator of dysphagia. Results: Home vs. Other Level of Care Of 3389 patients, 1668 were discharged home, 1721 to another level of care. Patients without tube feeds are 14.6 times more likely to be discharged home (P = <.0001, OR 14.66, 95% CI 8.05 to 26.69) Patients with NIHSS < 8 are 10.9 times more likely to be discharged home. IR vs. SNF Of 1546 patients, 983 were discharged to acute IR, 563 to SNF. Patients without tube feeds are 6.1 times more likely to be discharged to IR (P = <.0001, OR 6.118, 95% CI 4.34 to 8.63). Patients with NIHSS < 8 are 2.5 times more likely to be discharged to IR. SNF vs. Sub Of 738 patients, 563 were discharged to SNF, 175 to Sub. Patients without tube feeds are 3 times more likely to be discharged to SNF (P = <.0001, OR 2.999, 95% CI 2.048 to 4.390). Patients with NIHSS < 8 are 2 times more likely to be discharged to SNF. Conclusions: The absence of tube feeds as an indicator of dysphagia is a predictor of improved post-stroke disposition, with a correlation stronger than NIHSS. This study is limited by its retrospective nature and unmeasured psychosocial factors related to discharge. Prospective studies should focus on early diagnosis, therapeutic intervention and caregiver involvement in dysphagia education to improve outcomes and decrease the cost of post-stroke care.

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Abstract WP317: The Impact of Post-acute Discharge Disposition on Outcomes in the SWIFT PRIME Trial

Stroke ◽

10.1161/str.48.suppl_1.wp317 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Samir R Belagaje ◽

Diogo C Haussen ◽

Jeffrey L Saver ◽

Mayank Goyal ◽

David S Liebeskind ◽

...

Keyword(s):

Acute Stroke ◽

Skilled Nursing Facility ◽

Inpatient Rehabilitation ◽

Stroke Care ◽

Favorable Outcome ◽

Stroke Severity ◽

Acute Stroke Care ◽

Stroke Treatment ◽

Discharge Disposition ◽

The Impact

Intro: Post-acute stroke care in an inpatient rehabilitation facility (IRF) demonstrates better outcomes compared to a skilled nursing facility (SNF). With advancements in endovascular acute stroke, the impact that post-acute care plays is unclear. Here, we analyze a successful endovascular acute stroke trial to demonstrate that more improvement is seen in patients discharged to an IRF compared to a SNF. Methods: From SWIFT PRIME, a prospective, multi-center randomized acute endovascular trial, subject characteristics, and modified Rankin scores (mRS) were obtained. Post-acute hospital discharge was classified as home, IRF, and SNF. A favorable outcome was defined as 90 day mRS ≤ 2 and improvement was defined as ≥ 1 point decrease in mRS score. The effect of each disposition on a favorable outcome was calculated overall and stratified by stroke severity class (defined as discharge mRS 0-3, 4, 5) Results: A total of 165 subjects (mean age 64.8 years, mean initial NIHSS= 16.5, and 50 % male) were analyzed. Discharge disposition included: 51 (31%) going home, 92 (56%) IRF, 22 (13%) SNF. The baseline characteristics were similar between patients that went to IRF and SNF: age (p =0.76), gender (p= 0.81), baseline NIHSS (p=0.055), final infarct volumes (p=0.20), and recanalization rates (p=0.19). However, IRF subjects had lower NIHSS (p<0.001) and mRS (p=0.017) at day 7. Time to treatment defined as symptom onset to groin puncture was not significantly associated with discharge disposition (p=0.119). Only 1/22 (4.5%) subjects who were discharged to SNF achieved a 90 day mRS ≤2, compared to 41/92 (44.6%) in the IRF group or 48/51 (94.1%) in the home group (p < 0.001). When stratified by stroke severity: for mRS=0-3, there were no differences in favorable outcomes; mRS=4, 1/7 (14.3%) showed improvement at SNF compared to 21/27 (77.8%) at IRF (p=0.008); mRS =5, 5/14 (35.7%) showed improvement at SNF compared to 28/37 (75.7%) at IRF (p=0.013). Conclusions: Despite having similar characteristics following acute stroke treatment, not only did subjects who went to SNF compared to IRF have more unfavorable outcomes, they were less likely to make improvement. These findings show the continued importance of post-stroke rehabilitation, even in the endovascular era.

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Spatial Neglect Hinders Success of Inpatient Rehabilitation in Individuals With Traumatic Brain Injury

Neurorehabilitation and Neural Repair ◽

10.1177/1545968315604397 ◽

2015 ◽

Vol 30 (5) ◽

pp. 451-460 ◽

Cited By ~ 13

Author(s):

Peii Chen ◽

Irene Ward ◽

Ummais Khan ◽

Yan Liu ◽

Kimberly Hreha

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Length Of Stay ◽

Current Knowledge ◽

Inpatient Rehabilitation ◽

Functional Independence ◽

Spatial Neglect ◽

Future Research ◽

Discharge Disposition ◽

The Impact

Background. Current knowledge about spatial neglect and its impact on rehabilitation mostly originates from stroke studies. Objective. To examine the impact of spatial neglect on rehabilitation outcome in individuals with traumatic brain injury (TBI). Methods. The retrospective study included 156 consecutive patients with TBI (73 women; median age = 69.5 years; interquartile range = 50-81 years) at an inpatient rehabilitation facility (IRF). We examined whether the presence of spatial neglect affected the Functional Independence Measure (FIM) scores, length of stay, or discharge disposition. Based on the available medical records, we also explored whether spatial neglect was associated with tactile sensation or muscle strength asymmetry in the extremities and whether specific brain injuries or lesions predicted spatial neglect. Results. In all, 30.1% (47 of 156) of the sample had spatial neglect. Sex, age, severity of TBI, or time postinjury did not differ between patients with and without spatial neglect. In comparison to patients without spatial neglect, patients with the disorder stayed in IRF 5 days longer, had lower FIM scores at discharge, improved slower in both Cognitive and Motor FIM scores, and might have less likelihood of return home. In addition, left-sided neglect was associated with asymmetric strength in the lower extremities, specifically left weaker than the right. Finally, brain injury–induced mass effect predicted left-sided neglect. Conclusions. Spatial neglect is common following TBI, impedes rehabilitation progress in both motor and cognitive domains, and prolongs length of stay. Future research is needed for linking specific traumatic injuries and lesioned networks to spatial neglect and related impairment.

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Abstract TP298: Rapid Response Team Utilization for Inpatient Stroke Codes

Stroke ◽

10.1161/str.48.suppl_1.tp298 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Kunal Agrawal ◽

Christopher R Tainter ◽

Eema Hemmen ◽

Emily Botts ◽

Debra Paulson ◽

...

Keyword(s):

Acute Stroke ◽

Clinical Symptoms ◽

Rapid Assessment ◽

Skilled Nursing Facility ◽

Retrospective Chart Review ◽

Inpatient Rehabilitation ◽

Rapid Response Team ◽

Rapid Response ◽

Hospital System ◽

Discharge Disposition

Introduction: Rapid response teams (RRTs) are a way to provide rapid assessment and early intervention for inpatients with clinical deterioration, including those with acute stroke. The goal of this study is to examine the accuracy and outcomes of inpatient stroke code RRT activations within a hospital system. Methods: A retrospective chart review was performed for all RRT activations called for inpatient stroke codes within the UC San Diego Healthcare System from January 1, 2014 to November 30, 2015. Relevant variables included: clinical symptoms at the time of RRT initiation, neuroimaging modality (CT, CTA, MRI), IV rt-PA and/or endovascular therapy (ET), event diagnosis, and discharge disposition. We compared patients with diagnosis of stroke (AIS, ICH, SAH, other) versus non-stroke diagnosis. Diagnosis was determined by independent adjudication of provider documentation and corresponding acute and follow-up neuroimaging. Results: 285 of 2336 (12.2%) RRT activations were for stroke code. Ultimately, 31.2% (n=89) were diagnosed with stroke (61 AIS [68.5%], 17 ICH [19.1%], 2 SAH [2.3%], 2 epidural [2.3%] and 7 subdural hematomas [7.9%]). Of stroke codes, neuroimaging was used more often in patients diagnosed with stroke including CT (97.8% vs 89.3%, p=0.03), CTA (42.7% vs 29.6%, p=0.04), and MRI (28.1% vs 16.3%, p=0.03). Discharge disposition was home in 18.0% vs. 36.2% (p=0.001), skilled nursing facility in 22.5% vs. 27.6% (p=0.001), and inpatient rehabilitation in 11.2% vs. 3.6% (p=0.001). In-hospital mortality was higher in those with stroke (22.5% vs 10.7%, p=0.001). Only 18 patients (6.3%) received acute recanalization therapies (4 IV rt-PA, 12 ET, 2 both). Conclusions: Relatively few RRT stroke code activations diagnosed acute stroke and few received IV rt-PA and ET. Further studies are needed to better quantify the benefit of RRT in stroke code, explore additional benefits beyond acute recanalization therapies, and consider more targeted assessment for better resource utilization.

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Abstract P5: IV Alteplase Benefits Thrombectomy Patients With Incomplete TICI 2 Endovascular Reperfusion but Not Those With Complete TICI 3 Endovascular Reperfusion

Stroke ◽

10.1161/str.52.suppl_1.p5 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Jason W Tarpley ◽

Joseph T Ho ◽

Tamela L Stuchiner ◽

Renee Ovando ◽

Daniel Kelly ◽

...

Keyword(s):

Race And Ethnicity ◽

Skilled Nursing Facility ◽

Inpatient Rehabilitation ◽

Nursing Facility ◽

Term Care ◽

Skilled Nursing ◽

Stroke Registry ◽

Discharge Disposition ◽

Iv Tpa

Introduction: There is debate regarding how IV tPA influences the efficacy of Endovascular therapy (EVT). One hypothesized potential benefit of thrombolytics is in patients with incomplete endovascular reperfusion. We compared discharge disposition in EVT patients with TICI 2 or TICI 3 reperfusion who received IV tPA with those who did not. Methods: Data from the Providence System Stroke Registry for acute ischemic stroke patients receiving EVT between January 2015 and May 2020 with a TICI 2 or TICI 3 reperfusion grade were used. Patients presenting later than the conventional 4.5 hour IV tPA window were excluded. Multinomial regressions were used to assess if EVT patients with a TICI 2 or TICI 3 who received IV tPA compared to those who did not receive IV tPA had greater odds of being discharged as expired or hospice or other location (acute care or long term care, skilled nursing facility, left against medical advice), compared to home or inpatient rehabilitation (IRF), adjusting for patient age, sex, race and ethnicity, last known well to arrival, NIHSS at admit, and medical history. Adjusted odds ratios (AOR) and 95% confidence intervals (95% CI) are reported. Results: Of 419 EVT patients with TICI 2, 50.1% (n=210) received IV tPA and 49.9% (n=209) did not. Of 771 EVT patients with TICI 3, 48.4% (n=373) received IV tPA and 51.6% (n=398) did not. EVT patients with TICI 2 who were not treated with IV tPA were 59% less likely to be discharged as expired or hospice than home or IRF than those treated with IV tPA (AOR=0.414, 95% CI: 0.203, 0.844), and 63% less likely to be discharged somewhere other than home/IRF (AOR=0.372, 95% CI: 0.217, 0.636) than home/IRF. Among EVT patients with TICI 3, multivariate analyses indicated there was no greater likelihood of being discharged expired or to hospice than home/IRF (AOR=0.682, 95%CI: 0.434, 1.07) or discharged somewhere other than home/IRF (AOR=0.839, 95%CI: 0.592, 1.19) between those who received IV tPA and those who did not. Conclusions: Thrombectomy patients with TICI 2 reperfusion had better discharge outcome if they were treated with IV tPA. However, in completely reperfused patients with TICI 3 reperfusion outcome was not affected by prior IV tPA administration.

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Late Week Surgery Is Associated With Longer Length of Stay in Patients Undergoing Laminectomy for Degenerative Lumbar Stenosis

Neurosurgery ◽

10.1093/neuros/nyz310_709 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Robert Winkelman ◽

Vikram Chakravarthy ◽

Matthew M Grabowski ◽

Ghaith Habboub ◽

Sebastian Salas-Vega ◽

...

Keyword(s):

Postoperative Complications ◽

Length Of Stay ◽

Skilled Nursing Facility ◽

Inpatient Rehabilitation ◽

Nursing Facility ◽

Skilled Nursing ◽

Prolonged Length ◽

Degenerative Lumbar Spinal Stenosis ◽

Discharge Disposition ◽

Lumbar Spinal

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.

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