gms | German Medical Science

Objective: The concept of fast-track surgery (FTS) aims to shorten convalescence and reduce perioperative morbidity by improvement of clinical and organizational factors. One of the key parameters of FTS is the length of hospital stay (LOS), which is potentially influenced by multiple parameters. Little is known, however, about FTS in spinal neurosurgery. Thus, the purpose of this study was to identify factors related to a prolonged LOS for neurosurgical spine operations.

Methods: This prospective analysis of a retrospective database included consecutive patients ≥18 years of age undergoing a neurosurgical spine operation between 7.10.2016 and 25.11.2016. Patients receiving a neuromodulation procedure or a spinal infiltration were excluded. Demographic, intra- and perioperative data were extracted from electronic records including the Charlson Comorbidity Index (CCI) and specific pain-related (VAS, ODI, NDI) and quality of life (SF-8; higher value indicates lower quality of life) scores. Patient satisfaction (max: 100 pts.) was assessed with a 12-item-questionnaire ≥10 days after surgery. Univariate analysis was carried out to identify factors related to a prolonged (i.e., >median) LOS.

Results: 54 patients (f: n=21) with a median age 66 years were included. A total of 62 procedures were performed in the following spine regions: 28% cervical, 20% thoracic, and 52% lumbar. 39% of the operations were instrumented and 61% non-instrumented (microsurgical) procedures. The median LOS was 16 days (range: 3-46 days), 15 patients had a prolonged hospital stay. The median patient satisfaction was 84/100; the main reason for patient dissatisfaction was the postoperative physical therapy. Organizational factors related to a prolonged LOS were higher preoperative LOS (p<0.001), mainly due to logistical problems, and shorter interval between informed consent and surgery (p=0.002). Medical factors with a relationship to a prolonged LOS were higher CCI (p=0.003), longer duration of symptoms (p=0.005), lower preoperative haemoglobin (p=0.006), higher preoperative CRP (p=0.004) values, as well as higher ODI (p=0.002) and SF-8 (p=0.03) values at discharge. Lower patient satisfaction was clearly interrelated (p=0.001) with a longer LOS.

Conclusion: The LOS for a neurosurgical spine operation is influenced by various organizational and medical factors. Targeted intervention might help to reduce LOS and healthcare costs, and to improve patient satisfaction and convalescence.