Length of Stay Beyond Medical Readiness in a Neurosurgical Patient Population and Associated Healthcare Costs

• Published in: Neurosurgery Vol. 88; no. 3; pp. E259 - E264
• Main Authors: Linzey, Joseph R, Foshee, Rachel, Moriguchi, Francine, Adapa, Arjun R, Koduri, Sravanthi, Kahn, Elyne N, Williamson, Craig A, Sheehan, Kyle, Rajajee, Venkatakrishna, Thompson, B Gregory, Muraszko, Karin M, Pandey, Aditya S
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01.03.2021; Wolters Kluwer Health, Inc
• Subjects: Adult; Aged; Analysis; Cohort analysis; Cohort Studies; Continuity of Patient Care - trends; Dementia; Diabetes; Economic aspects; Female; Health Care Costs - trends; Health care expenditures; Hematoma; Humans; Intensive care; Kidney diseases; Length of stay; Length of Stay - trends; Liver diseases; Medical care, Cost of; Medical records; Middle Aged; Neurosurgery; Neurosurgical Procedures - trends; Nosocomial infections; Nursing; Patient Discharge - trends; Patients; Physical therapy; Prospective Studies; Recovery (Medical); Rehabilitation; Retrospective Studies; Risk Factors; Skilled Nursing Facilities - trends; United States; Variables; United States; Michigan; Healthcare costs; Hospital discharge; Length of stay
• ISSN: 0148-396X; 1524-4040
• DOI: 10.1093/neuros/nyaa535

Abstract BACKGROUND Length of stay beyond medical readiness (LOS-BMR) leads to increased expenses and higher morbidity related to hospital-acquired conditions. OBJECTIVE To determine the proportion of admitted neurosurgical patients who have LOS-BMR and associated risk factors and costs. METHODS We performed a prospective, cohort analysis of all neurosurgical patients admitted to our institution over 5 mo. LOS-BMR was assessed daily by the attending neurosurgeon and neuro-intensivist with a standardized criterion. Univariate and multivariate logistic regressions were performed. RESULTS Of the 884 patients admitted, 229 (25.9%) had a LOS-BMR. The average LOS-BMR was 2.7 ± 3.1 d at an average daily cost of $9 148.28 ± $12 983.10, which resulted in a total cost of $2 076 659.32 over the 5-mo period. Patients with LOS-BMR were significantly more likely to be older and to have hemiplegia, dementia, liver disease, renal disease, and diabetes mellitus. Patients with a LOS-BMR were significantly more likely to be discharged to a subacute rehabilitation/skilled nursing facility (40.2% vs 4.1%) or an acute/inpatient rehabilitation facility (22.7% vs 1.7%, P < .0001). Patients with Medicare insurance were more likely to have a LOS-BMR, whereas patients with private insurance were less likely (P = .048). CONCLUSION The most common reason for LOS-BMR was inefficient discharge of patients to rehabilitation and nursing facilities secondary to unavailability of beds at discharge locations, insurance clearance delays, and family-related issues.