Risk Factors for Ambulatory Surgery Conversion to Extended Stay Among Patients Undergoing One-level or Two-level Posterior Lumbar Decompression : Spine

Secondary Logo

Journal Logo

Advanced Search
Clinical Case Series

Risk Factors for Ambulatory Surgery Conversion to Extended Stay Among Patients Undergoing One-level or Two-level Posterior Lumbar Decompression

Dodo, Yusuke MD, PhDa,b; Okano, Ichiro MD, PhDa,b; Kelly, Neil A. MDc; Sanchez, Leonardo A. BAc; Haffer, Henryk MDa; Muellner, Maximilian MDa; Chiapparelli, Erika MDa; Oezel, Lisa MDa; Shue, Jennifer MSa; Lebl, Darren R. MDa; Cammisa, Frank P. MDa; Girardi, Federico P. MDa; Hughes, Alexander P. MDa; Sokunbi, Gbolabo MDa; Sama, Andrew A. MDa

Author Information

aSpine Care Institute, Hospital for Special Surgery, New York, NY

bDepartment of Orthopaedic Surgery, School of Medicine, Showa University Hospital, Tokyo, Japan

cWeill Cornell Medicine, New York, NY

The work was performed at Hospital for Special Surgery, New York, NY.

The study was conducted in accordance with the ethical principles of the Declaration of Helsinki and approved by the Institutional Review Board of the Hospital for Special Surgery.

Y.D., I.O., J.S., and A.A.S. conceived and designed the study; all authors participated in the planning, conduct, reporting, and interpretation of data. Y.D., I.O., H.H., M.M., L.O., J.S., N.A.K., and L.A.S. participated in acquisition of data. I.O. performed statistical analysis. Y.D. wrote the manuscript; all authors participated in revising the manuscript. Y.D., I.O., and A.A.S. accepts full responsibility for the work and conduct of this study, had access to the data, and controlled the decision to publish.

A.A.S. reports royalties from Ortho Development Corp.; private investments for Vestia Ventures MiRUS Investment LLC, ISPH II LLC, ISPH 3 LLC, and VBros Venture Partners X Centinel Spine; consulting fee from Clariance Inc., Kuros Biosciences AG, and Medical Device Business Service Inc.; speaking and teaching arrangements of DePuy Synthes Products Inc.; membership of the scientific advisory board of Clariance Inc., and Kuros Biosciences AG; and trips/travel of Medical Device Business research support from Spinal Kinetics Inc., outside the submitted work. F.P.C. reports royalties from NuVasive Inc.; private investments for 4WEB Medical/4WEB Inc., Accelus, Bonovo Orthopedics Inc., Healthpoint Capital Partners, LP, ISPH II LLC, ISPH 3 Holdings LLC, Ivy Healthcare Capital Partners LLC, Medical Device Partners II LLC, Medical Device Partners III LLC, Orthobond Corporation, Spine Biopharma LLC, Synexis LLC, Tissue Differentiation Intelligence LLC, VBVP VI LLC, VBVP X LLC (Centinel) and Woven Orthopedics Technologies; consulting fees from 4WEB Medical/4WEB Inc., DePuy Synthes Spine, NuVasive Inc., Spine Biopharma LLC, and Synexis LLC; membership of scientific advisory board/other office of Healthpoint Capital Partners, LP, Medical Device Partners III LLC, Orthobond Corporation, Spine Biopharma LLC, Synexis LLC, and Woven Orthopedic Technologies; and research support from 4WEB Medical/4WEB Inc., Mallinckrodt Pharmaceuticals, Camber Spine, and Centinel Spine, outside the submitted work. F.P.G. reports royalties from Lanx Inc., and Ortho Development Corp.; private investments for Centinel Spine, and BCMID; stock ownership of Healthpoint Capital Partners, LP; and consulting fees from NuVasive Inc., and DePuy Synthes Spine, outside the submitted work. A.P.H. reports research support from NuVasive Inc. and Kuros Biosciences AG; and fellowship support from NuVasive Inc. and Kuros Biosciences AG, outside the submitted work. D.R.L. reports royalties from NuVasive Inc. and Stryker; private investments from HS2 LLC, Woven Orthopedic Technologies, Vestia Ventures MiRus Investiment LLC, ISPH LLC; consulting fee from Depuy Synthes, Vizeon Inc.; scientific advisory board from Remedy Logic; and research support from Medtronic. The remaining authors report no conflicts of interest.

Address correspondence and reprint requests to Andrew A. Sama, MD, Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021; E-mail: [email protected]

Spine 48(11):p 748-757, June 1, 2023. | DOI: 10.1097/BRS.0000000000004621

Abstract

Study design: 

A retrospective observational study.

Objective. 

The objective of this study was to investigate the factors associated with the conversion of patient status from ambulatory surgery (AMS) to observation service (OS) (<48 h) or inpatient (>48 h).

Summary of Background Data. 

AMS is becoming increasingly common in the United States because it is associated with a similar quality of care compared with inpatient surgery, significant costs reduction, and patients’ desire to recuperate at home. However, there are instances when AMS patients may be subjected to extended hospital stays. Unanticipated extension of hospitalization stays can be a great burden not only to patients but to medical providers and insurance companies alike.

Materials and Methods. 

Data from 1096 patients who underwent one-level or two-level lumbar decompression AMS at an in-hospital, outpatient surgical facility between January 1, 2019, and March 16, 2020, were collected. Patients were categorized into three groups based on length of stay: (1) AMS, (2) OS, or (3) inpatient. Demographics, comorbidities, surgical information, and administrative information were collected. Simple and multivariable logistic regression analyses were conducted comparing AMS patients and OS/inpatient as well as OS and inpatients.

Results. 

Of the 1096 patients, 641 (58%) patients were converted to either OS (n=486) or inpatient (n=155). The multivariable analysis demonstrated that age (more than 80 yr old), high American Society of Anesthesiologists Physical Status (ASA) grade, history of sleep apnea, drain use, high estimated blood loss, long operation, late operation start time, and a high pain score were considered independent risk factors for AMS conversion to OS/inpatient. The risk factors for OS conversion to inpatient were an ASA class 3 or higher, coronary artery disease, diabetes mellitus, hypothyroidism, steroid use, drain use, dural tear, and laminectomy.

Conclusions. 

Several surgical factors along with patient-specific factors were significantly associated with AMS conversion. Addressing modifiable surgical factors might reduce the AMS conversion rate and be beneficial to patients and facilities.

© 2023 Wolters Kluwer Health, Inc. All rights reserved.

Full Text Access for Subscribers:

Not a Subscriber?

Buy
Request Permissions

You can read the full text of this article if you:

Access through Ovid