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Comparison of Perioperative Outcomes and Cost of Spinal Fusion for Cervical Trauma: Weekday Versus Weekend Admissions

Nandyala, Sreeharsha V. BA*; Marquez-Lara, Alejandro MD*; Fineberg, Steven J. MD*; Schmitt, Daniel R. BS; Singh, Kern MD*

doi: 10.1097/BRS.0000000000000020
Cervical Spine

Study Design. Retrospective database analysis.

Objective. To characterize the impact of the admission day (weekday vs. weekend) on the length of stay, costs, complications, and mortality in patients undergoing cervical spine surgery for spinal trauma.

Summary of Background Data. The effect of the admission day on the hospital outcomes for patients undergoing anterior cervical fusion (ACF), posterior cervical fusion (PCF), or anterior and posterior cervical fusion (APCF) to manage cervical spine trauma remains unknown.

Methods. The Nationwide Inpatient Sample was queried from 2002 to 2011. Patients undergoing an ACF, PCF, or APCF for the treatment of cervical spine trauma were identified. Patients were separated into cohorts based on the day of admission (weekday vs. weekend). Patient demographics, comorbidities, admission status, length of stay, costs, mortality, and outcomes were assessed. A value of P ≤ 0.001 denoted statistical significance due to the large sample size.

Results. A total of 34,122 patients underwent cervical fusion for cervical spine trauma between 2002 and 2011. Weekend admits accounted for 11.5% (n = 3126), 19.9% (n = 1048), and 17.2% (n = 301) of the ACF, PCF, and APCF procedures, respectively. On average, the weekend admits in all surgical approaches were younger, had a predilection toward more males, and demonstrated fewer comorbidities than the weekday cohort. ACF-treated weekend admits were hospitalized 4.4 days longer (P = 0.00001) and incurred $10,045 more in total hospital costs than the ACF-treated weekday admits (P = 0.0003). PCF-treated weekend admits were hospitalized 2.6 days longer (P = 0.0003) and incurred $10,227 more in total hospital costs (P = 0.0005). Finally, the APCF-treated weekend admits were hospitalized 4.2 days longer (P = 0.0004) and incurred $11,301 more in total hospital costs (P = 0.0001). The mortality rates were not significantly different among the admission-day cohorts. The ACF-treated weekend cohort demonstrated significantly greater incidences of postoperative infection (P = 0.0003), cardiac complications (P = 0.0004), and urinary tract infection (P = 0.0001) than their weekday admit counterparts.

Conclusion. The weekend cohorts in all surgical approaches incurred a greater length of stay and total hospital costs than their weekday counterparts. The ACF-treated weekend cohort demonstrated significantly greater incidences of postoperative infection, cardiac complications, and urinary tract infection. There were no significant differences in mortality based on the admission day for any surgical approach. Further research is warranted to further evaluate hospital utilization, costs, and patient outcomes based on the admission day.

Level of Evidence: 4

Weekend admits for cervical spine trauma requiring a surgical intervention demonstrated a greater length of stay (anterior cervical fusion [ACF]: 8.9 vs. 4.5 days; posterior cervical fusion [PCF]: 13.7 vs. 11.1 days; anterior and posterior cervical fusion [APCF]: 14.4 vs. 10.2 days) and total hospital costs (ACF: $27,572 vs. $17,527; PCF: $50,614 vs. $40,387; APCF $53,053 vs. $41,752) than weekday admits.

*Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL; and

Rush Medical College, Chicago, IL.

Address correspondence and reprint requests to Kern Singh, MD, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Ste #300, Chicago, IL 60612; E-mail:

Acknowledgment date: July 17, 2013. First revision date: August 24, 2013. Second revision date: August 29, 2013. Acceptance date: September 7, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, consultancy, and royalties.

© 2013 by Lippincott Williams & Wilkins