An article recently published in Spine compares the length of stay for patients after undergoing anterior cervical discectomy and fusion with and without corpectomy.
The research was conducted among 183 patients treated at an academic center over two years, 2011 to 2013. Since increased length of stay also increases the risk for complication and costs, the study authors were hoping to discover which factors made the biggest impact on hospital stays.
Here are five things to know about the study and ACDF surgery:
1. The average length of stay was 2.0±2.5 days. However, the facility and surgeon proficiency may impact length of stay. A 2011 study published in the Evidence Based Spine Care Journal examined 108 patients who underwent ACDF at an academic institution in the Midwest found the average LOS was 1.9±1.6 days.
2. The factors independently associated with an extended length of stay — three days or more — included:
• History of nonspinal malignancy
• History of pulmonary disease
• Procedures that included corpectomy.
The 2011 study factors also included older age, female gender, cardiac complications and urinary complications. Older patients stayed for an average of 2.5±1.2 days longer than patients under the age of 50.
3. Performing the procedure with a less invasive technique could shorten the length of stay as well. A 2011 study published in the Journal of Spinal Disorders & Techniques shows minimally invasive TLIF has shorter hospital length of stay, reduced postoperative narcotic use and quicker return to work than the open procedure. The MIS patients left the hospital in three days — compared to four to six days in the open group — and were able to return to work in 8.5 weeks — compared to 17.1 weeks for the open group.
4. According to the National Hospital Discharge Survey, ACDF procedures increased eight-fold from 1990 to 2004. The highest utilization was among patients 65 years or older, and the average age increased from 47.2 to 50.5 over the 14-year period. Hospital length of stay decreased from 5.17 days to 2.38 days on average and overall complication rate decreased from 4.6 percent to 3.03 percent. However, the prevalence of hypertension, diabetes, mellitus, obesity, pulmonary and coronary artery increased overtime among ACDF patients.
5. GlobalData recently reduced estimated growth in the spinal fusion market from 10 percent to 5 percent annually through 2020. Spinal fusions remain an expensive procedure and as a result payers are demanding more documentation before approving these procedures. Their reimbursement policies are changing and surgeons across the country are reporting more denials.
"Now the payers require extensive documentation to validate the medical necessity of the procedure, including well-documented attempts at conservative care and radiographic imaging to record the source of pain," said an analyst in the GlobalData report.
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