Disclosures: Salas-Vega reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
April 08, 2021
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Late-week surgery associated with increased length of stay after lumbar laminectomy

Disclosures: Salas-Vega reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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Elective lumbar laminectomy performed later in the week was associated with higher costs and prolonged length of stay, according to published results.

Sebastian Salas-Vega, PhD, and colleagues analyzed 1,359 patients within the Cleveland Clinic health system who underwent elective laminectomy surgery for degenerative lumbar spinal stenosis between March 1, 2016 and Feb. 1, 2019. Researchers performed generalized linear modeling to assess the relationships between day of surgery during a 5-day week, discharge disposition, length of stay (LOS) and total health care costs.

Salas-Vega graphic
LOS was “notably longer” for patients discharged to either a skilled nursing facility or rehabilitation center. Data were derived from Salas-Vega S, et al. J Neurosurg Spine. 2021;doi:10.3171/2020.11.SPINE201403.

Salas-Vega and colleagues found mean LOS increased throughout the week, with Thursday and Friday having “significantly longer hospital LOSs and costs,” according to the study. Mean LOS was 2.01 days for procedures done on a Monday, 2.04 days for those done on a Tuesday, 2.16 days on for those done a Wednesday, 2.64 days for those done on a Thursday and 2.47 days for those done on a Friday. Additionally, researchers highlighted that LOS was “notably longer” for patients discharged to either a skilled nursing facility or rehabilitation center. Investigators also found 20% greater total surgical costs for procedures performed on Friday vs. Monday, according to the study abstract.

Salas-Vega and colleagues concluded that while procedures performed later in the week resulted in greater costs of care and longer LOSs, there was no association with greater underlying health risks.

“These findings point to opportunities to lower costs and improve outcomes associated with elective surgical care,” the researchers wrote in the study. “Interventions to optimize surgical scheduling and perioperative care coordination could help reduce prolonged LOSs, lower costs, and, ultimately, give service-line management personnel greater flexibility over how to use existing resources as they remain ahead of health care reforms.”