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Comparison of Short-term Outcomes After Lumbar Fusion Between an Orthopedic Specialty Hospital and Tertiary Referral Center

Kreitz, Tyler M., MD; Tarazona, Daniel, MD; Padegimas, Eric M., MD; Foltz, Carol, PhD; Kepler, Christopher K., MD, MBA; Anderson, David Greg, MD; Vaccaro, Alexander R., MD, PhD, MBA; Hilibrand, Alan S., MD; Schroeder, Gregory D., MD

doi: 10.1097/BRS.0000000000002911
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Study Design. A retrospective review of all elective single-level lumbar fusions performed at a single orthopedic specialty hospital (OSH) and tertiary referral center (TRC).

Objective. This study compared the perioperative outcomes for lumbar fusion procedures performed at an OSH and TRC.

Summary of Background Data. The role of an OSH for lumbar fusion procedures has not been defined.

Methods. A large institutional database was searched for single-level lumbar fusions performed between 2013 and 2016. Comparisons were made between procedures performed at the OSH and TRC in terms of operative time, total operating room (OR) time, length of stay (LOS), inpatient rehabilitation utilization, postoperative 90-day readmission, reoperation, and mortality rates.

Results. A total of 101 patients at the OSH and 481 at the TRC were included. There was no difference in gender, age, age adjusted Charlson comorbidity Index (AACCI), body mass index, mean number of concomitant levels decompressed, and use of interbody fusion between OSH and TRC patients. The mean operative time (149.5 vs. 179.7 minutes, P < 0.001), total OR time (195.1 vs. 247.9 minutes, P < 0.001), and postoperative LOS (2.61 vs. 3.73 days, P < 0.001) were significantly shorter at the OSH. More patients required postoperative inpatient rehabilitation at the TRC (7.1% vs. 2%, P < 0.001). There was no difference in 90-day readmission or reoperation rates. There was one mortality at the TRC and two patients required transfer from the OSH to the TRC due to medical complications. Regression analysis demonstrated that procedures performed at the TRC (P < 0.001), total OR time (P = 0.004), AACCI (P < 0.001), current smokers (P = 0.048), and number of decompressed levels (P = 0.032) were independent predictors of LOS.

Conclusion. Lumbar fusion procedures may be safely performed at both the OSH and TRC. OSH utilization may demonstrate safe reduction in operative time, total OR time, and postoperative LOS in the appropriately selected patients.

Level of Evidence: 3

Perioperative outcomes following single-level lumbar fusions at an orthopedic specialty hospital and tertiary referral center were compared. Surgeries at an orthopedic specialty hospital resulted in shorter operative time and length of stay, without increasing the risk of readmissions or reoperations.

Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA.

Address correspondence and reprint requests to Daniel Tarazona, MD, Rothman Institute, 925 Chestnut St, Philadelphia, PA 19107; E-mail: Dan.tarazona@gmail.com

Received 4 May, 2018

Revised 25 August, 2018

Accepted 3 October, 2018

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

No funds were received in support of this work.

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

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