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Predicting Extended Length of Hospital Stay in an Adult Spinal Deformity Surgical Population

Klineberg, Eric O. MD; Passias, Peter G. MD; Jalai, Cyrus M. BA; Worley, Nancy BA; Sciubba, Daniel M. MD; Burton, Douglas C. MD; Gupta, Munish C. MD; Soroceanu, Alex MD; Zebala, Luke P. MD; Mundis, Gregory M. Jr. MD; Kim, Han Jo MD; Hamilton, D. Kojo MD; Hart, Robert A. MD; Ames, Christopher P. MD; Lafage, Virginie PhDInternational Spine Study Group

doi: 10.1097/BRS.0000000000001391

Study Design. A retrospective review of a prospective multicenter database.

Objective. The aim of this study was to identify variables associated with extended length of stay (ExtLOS) and this impact on health-related quality of life (HRQoL) scores in adult spinal deformity (ASD) patients.

Summary of Background Data. ASD surgery is complex and associated with complications including extLOS. Although variables contributing to extLOS have been considered, specific complications and pre-disposing factors among ASD surgical patients remain to be investigated.

Methods. Inclusion criteria: ASD surgical patients (age >18 years, scoliosis ≥20°, sagittal vertical axis ≥5 cm, pelvic tilt ≥25°, and/or thoracic kyphosis >60°) with complete demographic, radiographic, and HRQoL data at baseline, 6 weeks, and 2 years postoperative. ExtLOS was based on 75th percentile (≥9 days). Univariate and multivariate analyses identified predictors and evaluated effects on outcomes. Repeated-measures mixed models analyzed impact of ExtLOS on HRQoL [Oswestry Disability Index; Short Form-36 physical component summary/mental component summary; SRS22r Activity (AC), Pain (P), Appearance (AP), Satisfaction (S), Mental (M) and Total (T)].

Results. Three hundred eighty patients met inclusion criteria: 105 (27.6%) had extLOS (≥9 days) and 275 (72.4%) did not. Average LOS was 8 days (range: 1–30 days). Age [odds ratio (OR) 1.04], no. of levels fused (OR 1.12), no. of infections (OR 2.29), no. of neurologic complications (OR 2.51), Charlson Comorbidity Index Score (CCI) predicted ExtLOS (OR 3.92), and no. of intraop complications predicted ExtLOS (OR 3.56). ExtLOS patients had more intracardiopulmonary (pleural effusion: 1.9% vs. 0%) and operative complications (dural tear: 13.3% vs. 5.1%; excessive blood loss: 18% vs. 5.8%) (P < 0.022). At 2 years, both groups of patients experienced an overall improvement in all HRQoL scores (P < 0.001). ExtLOS patients had significantly less overall improvement in all HRQoLs (P < 0.01) except for MCS (P = 0.17) and SRS M (P = 0.08).

Conclusion. Extended LOS of ASD patients is affected by comorbidities (higher CCI) and number of intraoperative, but not peri-operative, complications. All patients improved overall in HRQoL scores, but extended LOS patients improved less overall at 2 years in comparison.

Level of Evidence: 3

*Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California

Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York

Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland

§Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas

Department of Orthopaedic Surgery, University of Calgary, Calgary, Alberta

||Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri

**San Diego Center for Spinal Disorders, La Jolla, California

††Department of Neurosurgery, Hospital for Special Surgery, New York, New York

‡‡Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburg, Pennsylvania

§§Department of Orthopaedic Surgery, Oregon Health Sciences University, Portland, Oregon

¶¶Department of Neurosurgery, University of California, San Francisco, California.

Address correspondence and reprint requests to Peter G. Passias, MD, New York Spine Institute, New York University Medical Center - Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003; E-mail:

Received 25 September, 2015

Revised 1 November, 2015

Accepted 17 November, 2015

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, grants, royalties, stocks, payment for lectures, patents, payment for lectures.

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