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J Spinal Disord Tech. 2014 Feb 12. [Epub ahead of print]

Factors Affecting Length of Stay and Complications Following Elective Anterior Cervical Discectomy and Fusion: A Study of 2164 Patients From The American College of Surgeons National Surgical Quality Improvement Project Database (ACS NSQIP).

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  • 1Yale University School of Medicine, Department of Orthopedics and Rehabilitation.

Abstract

STUDY DESIGN::

Retrospective review of the prospective American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP) database with 30-day follow-up of 2164 patients undergoing elective anterior cervical discectomy and fusion (ACDF).

OBJECTIVE::

To determine factors independently associated with increased length of stay (LOS) and complications following ACDF in order to facilitate preoperative planning and setting of realistic expectations for patients and providers.

SUMMARY OF BACKGROUND DATA::

The effect of individual preoperative factors on LOS and complications has been evaluated in small-scale studies. Large database analysis with multivariate analysis of these variables has not been reported.

METHODS::

The ACS NSQIP database from 2005-2010 was queried for patients undergoing ACDF procedures. Pre and perioperative variables were collected. Multivariate regression determined significant predictors (P<0.05) of extended LOS and complications.

RESULTS::

Average LOS was 2.0±4.0 days (mean±SD) with a range of 0 to 103 days. By multivariate analysis, age≥65, functional status, transfer from facility, preoperative anemia, and diabetes were the preoperative factors predictive of extended LOS. Major complications, minor complications, and extended surgery time were the perioperative factors associated with increased LOS. The elongating effect of these variables was determined, and ranged from 0.5-5.0 days. 71 (3.3%) had a total of 92 major complications, including return to OR (40), venous thrombotic events (13), respiratory (21), cardiac (6), mortality (5), sepsis (4), and organ space infection (3). Multivariate analysis determined ASA score≥3, preoperative anemia, age≥65, extended surgery time and male gender to be predictive of major complications (odds ratios ranging between 1.756-2.609) No association found between levels fused and LOS or complications.

CONCLUSION::

Extended LOS following ACDF is associated with factors including age, anemia, and diabetes, as well as the development of postoperative complications. One in 33 patients develops a major complication post-operatively, which are associated with an increased LOS of 5 days.

PMID:
24525748
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