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Neurosurgery. 2019 Jul 1;85(1):E60-E65. doi: 10.1093/neuros/nyy440.

Length of Stay Beyond Medical Readiness in Neurosurgical Patients: A Prospective Analysis.

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University of Michigan Medical School, Ann Arbor, Michigan.
Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan.
Department of Orthopedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri.



In an era of growing healthcare costs, there is increased pressure on medical care providers to discharge patients once they are medically fit. However, it is not uncommon for patients to stay beyond medical readiness (BMR).


To analyze the frequency with which patients remain in the hospital BMR.


A prospective cohort analysis utilizing a database maintained between 2014 and 2015 included 718 adults admitted to the neurosurgical service. The attending for admitted patients was asked on a daily basis as to whether the patient was medically cleared for discharge. Standard statistical analyses were performed.


Of the 718 patients, 105 (14.6%) remained in the hospital BMR. Of the patients who presented with a spinal pathology, 17.8% had a length of stay (LOS)-BMR compared to 13.9% who presented with cerebrovascular pathologies and 14.8% who presented with a brain tumor. The average LOS-BMR was 1.8 d. Only 7.7% of patients who were discharged home had an LOS-BMR compared to 30.7% of patients who were discharged to a skilled nursing facility or rehabilitation center (P < .001). In logistic regression, a physical therapy consultation and discharge to a specialized nursing facility were both associated with a longer LOS (average 2.4 d longer, P < .001, and 6.2 d longer, P = .028, respectively). However, neither was associated with an LOS-BMR.


LOS-BMR is an important process engineering concept within neurosurgery that represents a potential area for improvement to maximize limited healthcare resources. A sizeable portion of neurosurgical patients remained in the hospital BMR.


Discharge; Health costs; Length of stay; Medical readiness; Neurosurgery


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