COVID-19 Significantly Impacted Hospital Length of Stay and Discharge Patterns for Adult Spinal Deformity Patients.

Wang, Kevin Y; McNeely, Emmanuel L; Dhanjani, Suraj A; Raad, Micheal; Puvanesarajah, Varun; Neuman, Brian J; Cohen, David; Khanna, A Jay; Kebaish, Floreana; Hassanzadeh, Hamid; Kebaish, Khaled M

STUDY DESIGN Retrospective review. OBJECTIVE The primary aim was to compare length of stay (LOS) and discharge disposition of adult spinal deformity (ASD) patients undergoing surgery before and during the pandemic. Secondary aims were to compare the rates of 30-day complications, reoperations, readmissions, and unplanned emergency department (ED) visits. SUMMARY OF BACKGROUND DATA ASD patients often require extended LOS and non-routine discharge. Given resource limitations during the COVID-19 pandemic and caution regarding hospital stays, surgeons modified standard postoperative protocols to minimize patient exposure. METHODS We identified all patients who underwent elective thoracolumbar ASD surgery with ≥5 levels fusion at a tertiary care center during two distinct time intervals: Jul-Dec 2019 (Pre-COVID, N = 60) and Jul-Dec 2020 (During-COVID, N = 57). Outcome measures included LOS and discharge disposition (home vs. non-home), as well as 30-day major complications, reoperations, readmissions, and ED visits. Regression analyses controlled for demographic and surgical factors. RESULTS Patients who underwent ASD surgery during the pandemic were younger (61 vs. 67 years) and had longer fusion constructs (9 vs. 8 levels) compared to before the pandemic (p < 0.05 for both). On bivariate analysis, patients undergoing surgery during the pandemic had shorter LOS (6 vs. 9 days) and were more likely to be discharged home (70% vs. 28%) (p < 0.05 for both). After controlling for age and levels fused on multivariable regression, patients who had surgery during the pandemic had shorter LOS (IRR = 0.83, p = 0.015) and greater odds of home discharge (OR = 7.2, p < 0.001). Notably, there were no differences in major complications, reoperations, readmissions, or ED visits between the two groups. CONCLUSIONS During the COVID-19 pandemic, LOS for patients undergoing thoracolumbar ASD surgery decreased, and more patients were discharged home without adversely affecting complication or readmission rates. Lessons learned during the pandemic may help improve resource utilization without negatively influencing short-term outcomes.Level of Evidence: 3.