Research Fellow Rothman Orthopaedic Institute Rothman Orthopaedic Institute
Disclosure(s):
Joydeep Baidya, BS: No financial relationships to disclose
Introduction: Posterior cervical decompression and fusion (PCDF) is used for a wide range of degenerative cervical disease, and can have significant complication risk including C5 palsy, infection, and delayed wound healing. These adverse events can cause increased hospital stay (LOS) or readmission. However, no study has identified specific risk factors for these complications. This study aims to elucidate factors predictive of prolonged LOS and readmissions to improve preoperative counseling/optimization and postoperative care.
Methods: Adult patients who underwent PCDF at a tertiary care center (2017-2022) were retrospectively identified. Those with combined anterior-posterior approach or surgery for trauma, tumor, or infection were excluded. Patients were stratified into two groups based on LOS >2 or < 2 days, and on whether they were readmitted within 90 days postoperatively. Demographic and surgical characteristics were compared between groups using univariate analysis and multivariate regression for association with LOS and readmission.
Results: 378 patients met inclusion criteria. For LOS analysis, 76 patients were discharged within 2 days while 302 had extended LOS. Extended LOS was associated with higher CCI and home address in an at risk/distressed DCI quintile. All other demographic variables were similar for the two LOS groups. The extended length of stay group was associated with increased myelopathy indications, number of levels fused, estimated blood loss, cut-to-close time, and OR time. On multivariate regression, diabetes, CCI, cut to close time, myeloradiculopathy, and being in the at risk/distressed DCI quintile were independently predictive of LOS. For readmission analysis, 42 patients experienced a readmission versus 336 who did not. The readmission group was associated with increased LOS. On multivariate regression, LOS and current smoking status were independently predictive of readmission.
Conclusion : Extended LOS after PCDF was associated with increased medical comorbidities, more distressed/at risk domestic environment, and increased complexity of surgery. 90-day readmission after PCDF was associated with increased LOS and smoking. Both increased LOS and readmission are associated with worse outcomes and increased healthcare costs. Thus, further research should focus on 1.) optimizing these risk factors that are modifiable in the perioperative period, and 2.) identifying impactful postoperative protocols to give targeted extra care to vulnerable patients with non-modifiable factors.