COVID-19 Significantly Impacted Hospital Length of Stay and Discharge Patterns for Adult Spinal Deformity Patients

Kevin Y. Wang, BA; Emmanuel L. McNeely, BS; Suraj A. Dhanjani, BS; Micheal Raad, MD; Varun Puvanesarajah, MD; Brian J. Neuman, MD; David Cohen, MD; Akhil J. Khanna, MD; Floreana Kebaish, MD; Hamid Hassanzadeh, MD; Khaled M. Kebaish, MD

Disclosures

Spine. 2021;46(22):1551-1556. 

In This Article

Abstract and Introduction

Abstract

Study Design: Retrospective review.

Objective: The primary aim was to compare length of stay (LOS) and discharge disposition of adult spinal deformity (ASD) patients undergoing surgery before and during the pandemic. Secondary aims were to compare the rates of 30-day complications, reoperations, readmissions, and unplanned emergency department (ED) visits.

Summary of Background Data: ASD patients often require extended LOS and non-routine discharge. Given resource limitations during the Coronavirus Disease 2019 (COVID-19) pandemic and caution regarding hospital stays, surgeons modified standard postoperative protocols to minimize patient exposure.

Methods: We identified all patients who underwent elective thoracolumbar ASD surgery with more than or equal to five levels fusion at a tertiary care center during two distinct time intervals: July to December 2019 (Pre-COVID, N = 60) and July to December 2020 (During-COVID, N = 57). Outcome measures included LOS and discharge disposition (home vs. non-home), as well as 30-day major complications, reoperations, readmissions, and ED visits. Regression analyses controlled for demographic and surgical factors.

Results: Patients who underwent ASD surgery during the pandemic were younger (61 vs. 67 yrs) and had longer fusion constructs (nine vs. eight levels) compared with before the pandemic (P < 0.05 for both). On bivariate analysis, patients undergoing surgery during the pandemic had shorter LOS (6 vs. 9 days) and were more likely to be discharged home (70% vs. 28%) (P < 0.05 for both). After controlling for age and levels fused on multivariable regression, patients who had surgery during the pandemic had shorter LOS (IRR = 0.83, P = 0.015) and greater odds of home discharge (odds ratios [OR] = 7.2, P < 0.001). Notably, there were no differences in major complications, reoperations, readmissions, or ED visits between the two groups.

Conclusion: During the COVID-19 pandemic, LOS for patients undergoing thoracolumbar ASD surgery decreased, and more patients were discharged home without adversely affecting complication or readmission rates. Lessons learned during the pandemic may help improve resource utilization without negatively influencing short-term outcomes.

Level of Evidence: 3

Introduction

Starting in mid-March of 2020, the outbreak of Coronavirus Disease 2019 (COVID-19) led to large-scale changes in hospital practices across the United States, including protocols overseeing inpatient hospitalization for a variety of surgeries.[1–3] A recent national survey found that both patients and physicians have sought to reduce patient exposure to hospitals during the pandemic to limit resource utilization and prevent the spread of COVID-19.[4] As a result, the pandemic provided a unique opportunity to assess whether the changing practice patterns favoring shorter hospitalization could impact outcomes following major surgeries, such as adult spinal deformity (ASD) correction, which usually require longer hospital stays (LOS).

In the United States, ASD has a prevalence of up to 68% in adults over the age of 60.[5] Recent reviews have reported a 17% to 68% incidence of postoperative complications following ASD surgery, with around 42% of ASD patients requiring non-routine discharge.[6–10] To facilitate recovery and minimize the risk of complications, postoperative monitoring, and stabilization of patients in the inpatient setting is often needed. Prior studies have reported an average LOS of approximately 8 days following ASD surgery,[8,11,12] but it is currently unknown how the pandemic has impacted duration of hospital stay and complication rates in this patient population.

The primary aim of this study was to compare LOS and discharge disposition of ASD patients undergoing surgery before and during the pandemic. Secondary aims were to compare the rates of 30-day complications, readmissions, and emergency department (ED) visits before and during the pandemic. We hypothesized that the mean LOS after ASD surgery was lower during the pandemic compared with before, though that may have increased the rate of complications, readmissions, and/or ED visits. We also hypothesized that there would be a significant increase in the rate of home discharge following surgeries performed during the pandemic.

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