OBJECTIVE: For adult patients undergoing surgical decompression for Chiari malformation type I (CM-I), the patient-level factors that influence extended length of stay (LOS) are relatively unknown. The aim of this study was to investigate the impact of patient-baseline comorbidities, demographics, and postoperative complications on extended LOS after intervention after adult CM-I decompression surgery. METHODS: A retrospective cohort study using the National Inpatient Sample years 2010-2014 was performed. Adults (≥18 years) with a primary diagnosis of CM-I undergoing surgical decompression were identified. Weighted patient demographics, comorbidities, complications, LOS, disposition, and total cost were recorded. A multivariate logistic regression was used to determine the odds ratio for risk-adjusted LOS. RESULTS: A total of 29,961 patients were identified, 6802 of whom (22.7%) had extended LOS. The extended LOS cohort had a significantly greater overall complication rate (normal LOS, 10.6% vs. extended LOS, 29.1%; P < 0.001) and total cost (normal LOS, $14,959 ± $6037 vs. extended LOS, $25,324 ± $21,629; P < 0.001) compared with the normal LOS cohort. On multivariate logistic regression, black race, income quartiles, private insurance, obstructive hydrocephalus, lack of coordination, fluid and electrolyte disorders, and paralysis were all independently associated with extended LOS. Additional duraplasty (P = 0.132) was not significantly associated with extended LOS after adjusting for other variables. The odds ratio for extended LOS was 2.07 (95% confidence interval, 1.59-2.71) for patients with 1 complication and 9.47 (95% confidence interval, 5.86-15.30) for patients with >1 complication. CONCLUSIONS: Our study shows that extended LOS after adult CM-I decompression surgery may be influenced by multiple patient-level factors. Published by Elsevier Inc.
OBJECTIVE: For adult patients undergoing surgical decompression for Chiari malformation type I (CM-I), the patient-level factors that influence extended length of stay (LOS) are relatively unknown. The aim of this study was to investigate the impact of patient-baseline comorbidities, demographics, and postoperative complications on extended LOS after intervention after adult CM-I decompression surgery. METHODS: A retrospective cohort study using the National Inpatient Sample years 2010-2014 was performed. Adults (≥18 years) with a primary diagnosis of CM-I undergoing surgical decompression were identified. Weighted patient demographics, comorbidities, complications, LOS, disposition, and total cost were recorded. A multivariate logistic regression was used to determine the odds ratio for risk-adjusted LOS. RESULTS: A total of 29,961 patients were identified, 6802 of whom (22.7%) had extended LOS. The extended LOS cohort had a significantly greater overall complication rate (normal LOS, 10.6% vs. extended LOS, 29.1%; P < 0.001) and total cost (normal LOS, $14,959 ± $6037 vs. extended LOS, $25,324 ± $21,629; P < 0.001) compared with the normal LOS cohort. On multivariate logistic regression, black race, income quartiles, private insurance, obstructive hydrocephalus, lack of coordination, fluid and electrolyte disorders, and paralysis were all independently associated with extended LOS. Additional duraplasty (P = 0.132) was not significantly associated with extended LOS after adjusting for other variables. The odds ratio for extended LOS was 2.07 (95% confidence interval, 1.59-2.71) for patients with 1 complication and 9.47 (95% confidence interval, 5.86-15.30) for patients with >1 complication. CONCLUSIONS: Our study shows that extended LOS after adult CM-I decompression surgery may be influenced by multiple patient-level factors. Published by Elsevier Inc.
Entities:
Keywords:
Chiari I malformation; Extended length of stay; Suboccipital decompression
Authors: Katherine E Hekman; Leonardo Aliaga; David Straus; Aman Luther; Judy Chen; Ajay Sampat; David Frim Journal: Neurol Res Date: 2012-07-09 Impact factor: 2.448
Authors: Jacob K Greenberg; Travis R Ladner; Margaret A Olsen; Chevis N Shannon; Jingxia Liu; Chester K Yarbrough; Jay F Piccirillo; John C Wellons; Matthew D Smyth; Tae Sung Park; David D Limbrick Journal: Neurosurgery Date: 2015-08 Impact factor: 4.654
Authors: Travis R Ladner; Jacob K Greenberg; Nicole Guerrero; Margaret A Olsen; Chevis N Shannon; Chester K Yarbrough; Jay F Piccirillo; Richard C E Anderson; Neil A Feldstein; John C Wellons; Matthew D Smyth; Tae Sung Park; David D Limbrick Journal: J Neurosurg Pediatr Date: 2016-01-22 Impact factor: 2.375
Authors: Alfredo Avellaneda Fernández; Alberto Isla Guerrero; Maravillas Izquierdo Martínez; María Eugenia Amado Vázquez; Javier Barrón Fernández; Ester Chesa i Octavio; Javier De la Cruz Labrado; Mercedes Escribano Silva; Marta Fernández de Gamboa Fernández de Araoz; Rocío García-Ramos; Miguel García Ribes; Carmen Gómez; Joaquín Insausti Valdivia; Ramón Navarro Valbuena; José R Ramón Journal: BMC Musculoskelet Disord Date: 2009-12-17 Impact factor: 2.362