P79. The COVID-19 pandemic significantly impacted hospital length of stay and discharge patterns for ASD surgery

ABSTRACT

BACKGROUND CONTEXT During the COVID-19 pandemic, surgeons found ways to provide appropriate care while conserving inpatient resources and limiting potential exposure. For patients with adult spinal deformity (ASD), spine surgery often requires extended LOS and non-routine discharge. Given resource limitations during the COVID-19 pandemic and caution regarding hospital stays, surgeons have modified standard postoperative protocols to minimize patient exposure. PURPOSE The primary aim of this study was to compare LOS and discharge disposition of ASD patients undergoing surgery before and during the pandemic. Secondary aims were to compare the rates of 30-day complications, readmissions, and ED visits. STUDY DESIGN/SETTING Retrospective review of an institutional surgical registry. PATIENT SAMPLE A total of 117 patients with adult thoracolumbar deformity. OUTCOME MEASURES Outcome measures included LOS and discharge disposition (home vs non-home), as well as 30-day major complications, reoperations, readmissions and ED visits. 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 pandemic (p<0.05 for both). On bivariate analysis, patients undergoing surgery during the pandemic had significantly lower LOS (6 vs 8 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 continued to demonstrate a significantly lower LOS (IRR=0.83, p=0.015) and greater odds of home discharge (OR=7.2, p<0.001). Notably, there were no significant differences in reoperations, readmissions, ED visits, or major complications between the two groups (p>0.05 for all). CONCLUSIONS During the COVID-19 pandemic, the 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 outcomes. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.