Increased Length of Stay Predicts Unplanned Readmission in Patients Undergoing Lumbar Laminectomy

Introduction: There is strong clinical evidence supporting the lumbar decompressive laminectomy for the treatment of neurogenic claudication and radiculopathy due to degenerative lumbar stenosis. There has been a continued trend to decrease length of stay (LOS) for these frequently frail elderly patients. This study was performed to determine if there are any associations between LOS and postoperative outcomes including rates of unplanned readmission.

Methods: A consecutive cohort of patients who underwent lumbar laminectomy by a single surgeon between 2008 and 2022 at a tertiary academic medical center was evaluated. Patient characteristics including age, sex, ASA class, BMI, medical comorbidities, length of stay, and post-operative complications were evaluated.

Results: Seventy patients with a mean age of 64±15 years, mean BMI of 31.3±7.1, median ASA score of 3, and mean updated Charlson Comorbidity Index of 0.7±1.2 were included. Patients underwent a mean number of operative levels of 2.4±1.0, and 4% had a history of prior laminectomy. Median length of stay was 2 days. 8.6% of patients experienced a complication. 15.7% of patients had an intraoperative durotomy, and no patients had a CSF leak that required postoperative intervention. Older age (OR=1.22 [1.03, 1.46], p=0.024) and higher BMI (OR=1.30 [1.04, 1.62], p=0.021) were independently associated with any complication, while length of stay was not associated with morbidity (p=0.7788). Within 30 days of surgery, 1.4% of patients had an emergency department visit and 5.7% of patients were readmitted. Increased length of stay was associated with readmission within 30 days of admission (OR=1.54 [1.03, 2.29], p=0.035). Within 90 days of surgery, 5.7% of patients underwent subsequent reoperation for hematoma or wound dehiscence, and reoperation was independently associated with BMI (OR=1.18 [1.01, 1.38], p=0.036).

Conclusion : While length of stay was not associated with increased morbidity, patients with an increased length of stay were more likely to have an unplanned post-operative readmission.