Extended Length of Stay After Lumbar Spine Surgery: Sick Patients, Postoperative Complications, or Practice Style Differences Among Hospitals and Physicians?

Background: The degree to which extended length of stay (LOS) after surgery represents patient illness or postoperative complications is unknown. The aim of this study was to investigate the influence of postoperative complications and patient comorbidities on variance in extended length of hospital stay after lumbar spine surgery. Methods: Data from the American College of Surgeons National Surgical Quality Improvement Program were analyzed from January 1, 2008, through December 31, 2014. Study participants were 23,102 patients undergoing a 1-level or 2-level lumbar decompression and fusion procedure. Multivariable logistic regression analysis was used to determine the odds ratio for risk-adjusted extended length of hospital stay, defined as patients with a hospital stay greater than the 75th percentile (LOS >5 days) for the cohort. The primary outcome was the extent to which extended LOS represented preoperative patient illness or postoperative complications. Results: Of 23,102 participants, 3794 (16.42%) had extended LOS. Most patients (2849 patients; 75.10%) with extended LOS did not have a documented postoperative complication. Only a minority of patients with extended LOS had a history of comorbidities known to influence outcomes in patients undergoing spine surgery, including diabetes (24%), chronic obstructive pulmonary disease (7%), congestive heart failure (0.69%), myocardial infarction (0.20%), acute renal failure (0.26%), and stroke (2.23%). Conclusions: This study suggests that much of the variation in LOS after lumbar spine surgery is not attributable to baseline patient illness or complications and most likely represents differences in practice style or surgeon preference.