Analysis Of Factors Related To Hospital Stay In Elderly Patients With Lumbar Degenerative Disease By Posterior Lumbar Fusion Surgery

Objective:To determine the clinically independent factors associated with prolonged hospital length of stay(LOS)after posterior lumbar fusion surgery in elderly patients with lumbar degenerative disease,thereby facilitating preoperative planning for spinal surgeons and setting of realistic expectations for patients and providers.Materials and Methods:We retrospectively analyzed the clinical data of 303 elderly patients(age range: 60-86 years)with lumbar degenerative diseases who underwent posterior lumbar fusion surgery at the Spine Center of the Orthopedic Hospital of the First Affiliated Hospital of Nanchang University from December 2013 to December 2017.All patients' demographic characteristics,preoperative complications,LOS,and postoperative complications were recorded,and univariate and multivariate logistic regression analysis were used to determine the significant predictors of LOS prolongation.Result:The average age of all patients was 67.0 ± 5.5 years,the average LOS was 18.5 ± 11.8 days(range: 7-103 days).Of the total,166 patients(54.8%)were men,137 patients(45.2%)were female,and 34 patients(11.2%)had postoperative complications.The common postoperative complications include lung infection(8,2.64%),unplanned reoperation(6,1.98%),postoperative nerve compression(5,1.65%),cerebrospinal fluid leakage(4,1.32%),sepsis/septicemia shock(2,0.66%),and infectious complications such as wound infections(16,5.28%)and urinary tract infections(6,1.98%).The average LOS of patients with major complications was 35.36 ± 17.69 days,while the average LOS of patients without major complications was 15.42 ± 6.95 days(P <0.001).In addition,the average LOS of patients with infectious complications was 33.38 ± 14.60 days,while the average LOS of patients without infectious complications was 15.43 ± 8.43 days(P <0.001).Multivariate Logistic regression analysis determined that age?70 years(P <0.001),pulmonary comorbidities(P = 0.010),and diabetes(P = 0.010)were preoperative factors independently associated with prolonged LOS.Major complications(P = 0.002),infectious complications(P = 0.001),unscheduled reoperations(P <0.001),and intraoperative estimated blood loss(P = 0.018)were perioperative factors independently associated with prolonged LOS.Among them,age?70 years(P <0.001),infectious complications(P <0.001),and unplanned reoperation(P <0.001)were significant predictors of prolonged LOS.Conclusion:The length of hospital stay in elderly patients with lumbar degenerative disease after posterior lumbar fusion surgery is significantly related to age,infectious complications and unplanned reoperation and other postoperative complications.Spine surgeons should recognize and notice these significant related factors,and take appropriate precautions to optimize the modifiable factors to reducing the LOS as well as hospitalization costs,while using non-optimizable factors for preoperative patient consultation and postoperative planning.