Sarasota, FL (WorkersCompensation.com) – A recent study published in the Journal of Neurosurgery suggests you might want to think twice about scheduling that spinal surgery at the end of the week.
In light of new payment model alternatives that offer incentives to keep costs down, researchers from the London School of Economics and Political Science and Cleveland Clinic set out to examine potential factors that drive the hospital length of stay and cost of surgical procedures. The researchers reviewed the records of 1,359 adult patients that had undergone an elective laminectomy surgery for degenerative lumbar spinal stenosis between March 2016 and February 2019.
Lumbar laminectomy is a relatively straight-forward procedure with a commonly predictable course of care that is often included in bundled payment programs due to that very reason. While the procedure has traditionally been performed in an inpatient setting, the push in recent years has been the ambulatory surgery setting to decrease patient length of stay, resulting in reduced costs.
The researchers looked for a correlation between the day of the surgery and length of stay, and factored in such elements as comorbidities and age, type of facility, and discharge orders.
The average age of the patients reviewed was between 64 and 68 years of age, with age 64 the average for Fridays, and 68 the average for Tuesdays. The patients whose surgeries occurred on Tuesdays and Wednesdays were most commonly done in a tertiary care center. Those that underwent surgery on Monday were most often patients in a regional community hospital. Tuesdays were the least likely days for patients covered by private or commercial insurance, and Thursdays and Fridays were the least likely days for Medicare patients. The highest averages for worker’s compensation surgeries occurred on Fridays and Wednesdays.
The researchers found that the later in the week the procedure was performed, the higher the cost of care. The average length of stay for surgeries performed on a Monday was 2.01 days; however the length of stay increased to 2.47 days if the surgery occurred on a Friday, resulting in a 20 percent increase in costs.
Additionally, patients whose plan of care resulted in a skilled nursing or rehabilitation center following treatment later in the week saw the same results. If patients were discharged later in the week, the total cost was 21.5 percent higher than if they had been discharged earlier in the week. The results held steady among all insurance groups that were reviewed.
The full study results are available for download on the Journal Of Neurosurgery website.