The authors sought to distinguish between the clinical and nonclinical drivers of patient length of stay (LOS) in the hospital following elective lumbar laminectomy—a common spinal surgery that may be reimbursed using bundled payments—and to understand their relationships with patient outcomes and costs in a healthcare landscape where costs are increasingly important. This study looked at patients under the age of 18 who had laminectomy surgery for degenerative lumbar spinal stenosis at the Cleveland Clinic between March 1, 2016, and February 1, 2019. While correcting for underlying patient heaviness, generalised linear models was used to analyse the connections between the day of operation, patient discharge disposition, and hospital LOS.

For Monday and Friday cases, the mean LOS was 2.01 and 2.47 days, respectively. Patients who were eventually discharged to a skilled nursing facility (SNF) or a rehabilitation centre had a significantly longer LOS. The data was best fit by a Poisson generalised linear model, which revealed that comorbidity burden, surgery at a tertiary care centre versus a community hospital, and the incidence of any complication were all factors. Late-week surgeries are linked to a longer LOS, especially if the patient is discharged to a skilled nursing facility or a rehabilitation centre. These findings hint to cost-cutting and outcome-improvement opportunities in elective surgical care. Surgical scheduling and perioperative care coordination interventions could help reduce long LOSs, save costs, and, ultimately, improve service quality.

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