296 Associated Risk Factors for Extended Length of Stay following Pediatric Tethered Cord Release: An Analysis of 2012 – 2021 NSQIP-Pediatric Database

INTRODUCTION: The factors associated with prolonged hospitalization following surgical release of tethered spinal cord in pediatric patients are relatively unknown. METHODS: A retrospective cohort study was performed using the 2012-2021 ACS NSQIP-Pediatric database. Patients undergoing laminectomy with release of a tethered spinal cord were identified using CPT and ICD-9/10 codes. Patients were dichotomized into two cohorts based on whether they experienced an extended postoperative hospital LOS, defined as a LOS greater than the 75th percentile for the entire cohort (3 days). Patient demographics, comorbidities, adverse events, and healthcare resource utilization were assessed. Predictors of extended LOS were identified using multivariate logistic regression analysis. RESULTS: Among the 10,196 studied patients undergoing laminectomy with tethered cord release, 2,077 experienced an extended LOS. The extended LOS-cohort was significantly older than the normal LOS cohort (Normal LOS: 5.44 ± 4.70 years vs. Extended LOS: 7.11 ± 5.27, p<0.001) and more frequently Hispanic, Asian, or of “other or unknown” racial identity (p<0.001). Overall, complications, unplanned readmission, and reoperation rates were higher among the extended LOS cohort (p<0.001). On multivariate logistic regression, independent associations of extended LOS included age, race and ethnicity, ASA classification, impaired cognitive status, cardiac risk factors, neuromuscular disorders, and tracheostomies. CONCLUSIONS: Our study reveals that age, race, comorbidities, and perioperative complications contribute to prolonged LOS after surgical release of tethered spinal cord among pediatric patients. Additional investigations to further understand the risk factors of extended LOS are warranted to improve patient outcomes.