Does day of surgery affect length of stay and hospital charges following lumbar decompression?

Abstract

Study Design: This is a retrospective cohort study. Introduction: Spine procedures are the most expensive surgical interventions on a per-case basis. Previously, orthopedic procedures occurring later in the week have been associated with an increased length of stay (LOS) and consequent increase in costs. However, no such analysis has been performed on common spinal procedures such as minimally invasive lumbar decompression (MIS LD). The purpose of this study is to determine if there is an association between day of surgery and LOS or direct hospital costs after MIS LD. Materials and Methods: A prospectively maintained surgical database of patients who underwent primary, single, or multilevel MIS LD for degenerative spinal pathology between 2008 and 2017 was reviewed. Patients undergoing MIS LD were grouped as early in the week (Monday/Tuesday) or late in the week (Thursday/Friday). Differences in patient demographics and preoperative characteristics were compared using χ 2 analysis or Student’s t-test. Associations between date of surgery, LOS, and costs were assessed using multivariate linear regression. Results: A total of 717 patients were included. Of these, 420 (58.6%) were in the early surgery cohort and 297 (41.4%) were in the late surgery cohort. There were no differences in demographic characteristics, operative levels, operative time, blood loss, or hospital LOS between cohorts ( p > 0.05). Furthermore, there was no difference in total direct costs or specific cost categories between cohorts ( p > 0.05). Discussion: The timing of surgery within the week is not associated with differences in inpatient LOS or hospital costs following MIS LD. As such, hospitals should not alter surgical scheduling patterns to restrict these procedures to certain days within the week.