Factors Affecting Postoperative Length of Stay in Patients Undergoing Anterior Lumbar Interbody Fusion (ALIF).

Abstract

BACKGROUND\nWith hospital leaders and policymakers increasingly seeking ways to improve resource utilization, there has been heightened interest in reducing hospital length of stay (LOS) and performing spine procedures on an outpatient basis. We aimed to determine which risk factors correlated with prolonged LOS following anterior lumbar interbody fusion (ALIF).\n\n\nMETHODS\nMedical records for patients who underwent ALIF were retrospectively reviewed. Patients were divided into those who had extended (>3 days) versus non-extended (<3 days) LOS and patient demographics, medical comorbidities, and preoperative medications were analyzed. Univariate and multivariate regression were then utilized to determine preoperative risk factors for extended LOS.\n\n\nRESULTS\nA total of 166 patients were included (mean age, 48.7 years). Medical comorbidities included hypertension (31.9%), diabetes (8.4%), and obesity (body mass index >30 kg/m2) (48.8%). LOS was not extended in 121 patients and extended in 45. Mean LOS was 2.2 days (95% confidence interval [Cl] 1.9-2.5). On multivariate logistic analysis, age ≥65 years (p=0.001), preoperative benzodiazepine use (p=0.014), 12-item Short Form mental score (SF-12 MCS) (p=0.008), estimated blood loss (p=0.015), time to mobilization (p<0.001), and total operative time (p=0.020) were independent predictors for extended LOS.\n\n\nCONCLUSIONS\nAs attempts are made to perform more spine procedure in ambulatory surgical centers, strict patient selection criteria are all critical in making this possible. Our results suggested that age, preoperative benzodiazepine use, higher intraoperative blood loss, delayed mobilization, and lower SF-12 MCS were correlated with increased LOS. Therefore, inpatient ALIF may be more suitable for patients with these risk factors.