Comparison of Length of Stay and Discharge Disposition After Short-Segment Lumbar Fusion Surgery at Tertiary Care and Nontertiary Care Hospitals: A Propensity Score-Matched Analysis.

Authors

• Rajkishen Narayanan
• Olivia A Opara
• Adam Kohring
• Yunsoo Lee
• Preston Carey
• Rioke M Diejomaoh
• Cordero McCall
• Sean Lowitz
• Julian Takagi-Stewart
• Evan Bradley
• Mark F Kurd
• Ian D Kaye
• John J Mangan
• Jose A Canseco
• Alan S Hilibrand
• Alexander R Vaccaro
• Christopher K Kepler
• Gregory D Schroeder

Publication/Presentation Date

10-1-2026

Abstract

STUDY DESIGN: A retrospective study.

OBJECTIVE: To compare the perioperative and postoperative outcomes among lumbar fusion patients treated at an orthopedic specialty hospital (OSH), a hybrid community hospital (HCH), and a conventional community hospital in comparison to a tertiary care hospital (TCH).

SUMMARY OF BACKGROUND DATA: In spine surgery, strategies to reduce length of stay (LOS) include a myriad of pre-, intra-, and postoperative strategies that require a multidisciplinary infrastructure. The sum of these efforts has led to the creation of orthopedic specialty hospitals and protocols that have been adopted by community hospitals as well. There is a notable lack of information regarding the results of these efforts across different healthcare institution models.

METHODS: This was a retrospective study of patients undergoing elective one or two-level lumbar fusion between 2017 and 2022 at a large urban TCH, an OSH, a HCH, and a conventional CH. Data were collected on patient characteristics, demographics, comorbidities, BMI, smoking status, surgical type, surgical levels, surgery duration, hospital length of stay, readmissions, reoperations, and discharge status within a year. Patients across the four surgical settings were matched based on age, BMI, CCI, type of procedure, and number of levels fused.

RESULTS: A total of 1435 patients met the inclusion criteria. Length of hospital stay was significantly longer at TCH compared with OSH, HCH, and CH by an average of 1 to 2 days ( P < 0.001). Ninety-day readmissions were higher at TCH compared with OSH ( P =0.001). TCH patients also were less likely to be discharged home than OSH and HCH patients ( P =0.001 and P =0.016, respectively). No significant differences were noted in 1-year reoperation rates across all hospital models.

CONCLUSIONS: Shorter lengths of stays and more home discharges at the orthopedic specialty hospital and community hospital settings did not compromise surgical quality or postoperative outcomes.

LEVEL OF EVIDENCE: Level III.

Volume

51

Issue

19

First Page

1414

Last Page

1417

ISSN

1528-1159

Published In/Presented At

Narayanan, R., Opara, O. A., Kohring, A., Lee, Y., Carey, P., Diejomaoh, R. M., McCall, C., Lowitz, S., Takagi-Stewart, J., Bradley, E., Kurd, M. F., Kaye, I. D., Mangan, J. J., Canseco, J. A., Hilibrand, A. S., Vaccaro, A. R., Kepler, C. K., & Schroeder, G. D. (2026). Comparison of Length of Stay and Discharge Disposition After Short-Segment Lumbar Fusion Surgery at Tertiary Care and Nontertiary Care Hospitals: A Propensity Score-Matched Analysis. Spine, 51(19), 1414–1417. https://doi.org/10.1097/BRS.0000000000005070

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

38899968

Department(s)

Administration and Leadership

Document Type

Article