Factors associated with increased length of stay in degenerative cervical spine surgery: a cohort analysis from the Canadian Spine Outcomes and Research Network

Eryck Moskven; Greg McIntosh; Andrew Nataraj; Sean D Christie; Rajesh Kumar; Philippe Phan; Zhi Wang; Bilal Tarabay; Michael H Weber; Supriya Singh; Christopher S Bailey; Neil A Manson; Edward Abraham; Jérôme Paquet; Jefferson R Wilson; Y Raja Rampersaud; Charles G Fisher; Nicolas Dea; Raphaële Charest-Morin

doi:10.3171/2024.1.SPINE231211

Factors associated with increased length of stay in degenerative cervical spine surgery: a cohort analysis from the Canadian Spine Outcomes and Research Network

J Neurosurg Spine. 2024 Apr 5:1-10. doi: 10.3171/2024.1.SPINE231211. Online ahead of print.

Authors

Eryck Moskven¹, Greg McIntosh², Andrew Nataraj³, Sean D Christie⁴, Rajesh Kumar⁵, Philippe Phan⁶, Zhi Wang⁷, Bilal Tarabay⁷, Michael H Weber⁷, Supriya Singh⁸, Christopher S Bailey⁸, Neil A Manson⁹, Edward Abraham⁹, Jérôme Paquet¹⁰, Jefferson R Wilson¹¹, Y Raja Rampersaud¹², Charles G Fisher¹, Nicolas Dea¹, Raphaële Charest-Morin¹

Affiliations

¹ 1Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic Surgery, University of British Columbia, Vancouver, British Columbia.
² 2Canadian Spine Society, Markdale, Ontario.
³ 3Division of Neurosurgery, University of Alberta, Edmonton, Alberta.
⁴ 4Department of Surgery, Dalhousie University, Halifax, Nova Scotia.
⁵ 5Spine Program, Sunnybrook Health Sciences Centre, Department of Surgery, University of Toronto, Ontario.
⁶ 6Division of Orthopaedic Surgery, University of Ottawa, Ontario.
⁷ 7Department of Orthopedic Surgery, University of Montreal Health Center, Montreal, Quebec.
⁸ 8London Health Science Centre Combined Orthopaedic and Neurosurgery Spine Program, Schulich School of Medicine, Western University, London, Ontario.
⁹ 9Division of Orthopaedics, Canada East Spine Centre, Saint John, New Brunswick.
¹⁰ 10Centre de Recherche CHU de Québec, CHU de Québec-Université Laval, Québec.
¹¹ 11Divisions of Orthopaedic and Neurosurgery, University of Toronto, Ontario; and.
¹² 12Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Orthopaedics, Department of Surgery, Division of Orthopaedic Surgery, University of Toronto, Ontario, Canada.

PMID: 38579341
DOI: 10.3171/2024.1.SPINE231211

Abstract

Objective: Postoperative length of stay (LOS) significantly contributes to healthcare costs and resource utilization. The primary goal of this study was to identify patient, clinical, surgical, and institutional variables that influence LOS after elective surgery for degenerative conditions of the cervical spine. The secondary objectives were to examine the variability in LOS and institutional practices used to decrease LOS.

Methods: This was a multicenter observational retrospective cohort study of patients enrolled in the Canadian Spine Outcomes and Research Network (CSORN) between January 2015 and October 2020 who underwent elective anterior cervical discectomy and fusion (ACDF) (1-3 levels) or posterior cervical fusion (PCF) (between C2 and T2) with/without decompression for degenerative conditions of the cervical spine. Prolonged LOS was defined as LOS greater than the median for the ACDF and PCF populations. The principal investigators at each participating CSORN healthcare institution completed a survey to capture institutional practices implemented to reduce postoperative LOS.

Results: In total, 1228 patients were included (729 ACDF and 499 PCF patients). The median (IQR) LOS for ACDF and PCF were 1.0 (1.0) day and 5.0 (4.0) days, respectively. Predictors of prolonged LOS after ACDF were female sex, myelopathy diagnosis, lower baseline SF-12 mental component summary score, multilevel ACDF, and perioperative adverse events (AEs) (p < 0.05). Predictors of prolonged LOS after PCF were nonsmoking status, education less than high school, lower baseline numeric rating scale score for neck pain and EQ5D score, higher baseline Neck Disability Index score, and perioperative AEs (p < 0.05). Myelopathy did not significantly predict prolonged LOS within the PCF cohort after multivariate analysis. Of the 8 institutions (57.1%) with an enhanced recovery after surgery (ERAS) protocol or standardized protocol, only 3 reported using an ERAS protocol specific to patients undergoing ACDF or PCF.

Conclusions: Patient and clinical factors predictive of prolonged LOS after ACDF and PCF are highly variable, warranting individual consideration for possible mitigation. Perioperative AEs remained a consistent independent predictor of prolonged LOS in both cohorts, highlighting the importance of preventing intra- and postoperative complications.

Keywords: ACDF; ERAS; degenerative; enhanced recovery after surgery; health economics; health policy; length of stay; posterior cervical fusion; risk factors.