RT Journal Article
SR Electronic
T1 Increasing Patient Complexity Is Associated With Longer In-Hospital Lengths of Stay and Higher Rates of Medical Complications Following Primary 1- to 2-Level Lumbar Fusion
JF International Journal of Spine Surgery
JO Int J Spine Surg
FD International Society for the Advancement of Spine Surgery
SP 8364
DO 10.14444/8364
A1 Geoffrey W. Cloud
A1 Shreya Jain
A1 Adam M. Gordon
A1 Aaron W. Lam
A1 Andrew R. Horn
A1 Ahmed Saleh
A1 Afshin E. Razi
YR 2022
UL http://ijssurgery.com//content/early/2022/11/08/8364.abstract
AB Background The Elixhauser Comorbidity Index (ECI) is a stratification tool to predict adverse surgical outcomes. No studies have explored the relationship between ECI and outcomes following primary 1- to 2-level lumbar fusion (1-2LF). The purpose was to determine whether an ECI score greater than 1 correlated with (1) longer in-hospital length of stay (LOS) and (2) greater odds of developing 90-day medical complications.Methods A retrospective review from 2004 to 2015 was performed using the Medicare Standard Analytical Files for patients undergoing primary LF. Patients with ECI scores from 2 to 5 served as the study cohorts (1 for each ECI score), and patients with an ECI score of 1 served as the control cohort. In-hospital LOS and 90-day medical complications were compared between cohorts. A P value of <0.001 was statistically significant.Results A total of 105,120 patients were equally distributed between the 5 cohorts. Patients with an ECI score of 2 (6.00 ± 4.51), ECI 3 (6.22 ± 4.67), ECI 4 (7.35 ± 5.05), or ECI 5 (8.99 ± 5.67) had longer in-hospital LOS compared with patients with an ECI score of 1 (4.28 ± 4.36) (all P < 0.001). Patients with an ECI score of 2 (OR: 1.17, 95% CI: 1.05–1.30, P = 0.003; 2.85% vs 2.45%), ECI 3 (OR: 1.22, 95% CI: 1.10–1.36, P < 0.001; 2.98% vs 2.45%), ECI 4 (OR: 1.26, 95% CI: 1.13–1.40, P < 0.001; 3.10% vs 2.45%), or ECI 5 (OR: 1.18, 95% CI: 1.06–1.31, P = 0.001; 2.89% vs 2.45%) had greater incidence and odds of 90-day medical complications such as pneumonia, deep vein thrombosis, cerebrovascular accidents, and myocardial infarctions than patients in the control group (all P < 0.0001).Conclusions Increasing ECI score was associated with longer in-hospital LOS and increased 90-day medical complication rates following 1-2LF. This study is the first to establish a correlation between ECI score, in-hospital LOS, and complication rates following lumbar fusion.Clinical Relevance ECI score may assist physicians in adjusting pre- and postoperative care for complex patients undergoing 1-2LF.Level of Evidence 3.