Factors Correlated With Increased Surgical Duration, Length of Stay, and Cost of Admission for 3-Level Anterior Cervical Discectomy and Fusion

Study Design: Retrospective. Objective: To identify factors correlated with surgical duration, LOS, and COA for 3-level ACDF. Background: Three-level ACDF can treat multilevel spine pathologies, but is associated with higher complexity and increased risk profiles compared with single- and 2-level ACDF. This study examined factors affecting surgical duration, length of stay (LOS), and costs of admission (COA) specifically for patients undergoing 3-level ACDF to identify patients at higher risk of these adverse outcomes. Methods: Patient demographics, baseline health factors, and perioperative outcomes were retrospectively collected for patients undergoing 3-level ACDF. Univariable analysis correlated each variable with increased surgical duration, LOS, and COA as outcomes. Patient comorbidities and functional status were incorporated into conceptual multivariable regression models for each outcome variable. Results: The cohort included 137 patients with a mean age of 59.1±11.3 years. Seventy-one (51.8%) patients were male, with a median (IQR) surgical duration of 211.5 (70) minutes, LOS of 2 (2) days, and COA of $39,998 ($12,329). On multivariable analysis, hypertension was associated with extended surgical duration (OR=3.00, 95% CI: 1.16–8.44, P =0.028); total functional dependence (OR=7.70, 95% CI: 1.26–59.57, P =0.033), cerebrovascular disease (OR=6.51, 95% CI: 1.05–37.43, P =0.034), and diabetes (OR=10.33, 95% CI: 3.09–37.95, P <0.001) were associated with extended LOS; COPD (OR=8.32, 95% CI: 1.60–50.36, P =0.014) and diabetes (OR=8.00, 95% CI: 1.96–37.05, P =0.005) were associated with increased COA. In addition, patients who are Black experienced higher risks of extended surgical duration (OR=5.84, 95% CI: 1.85–20.25, P =0.003) and LOS (OR=6.01, 95% CI: 1.47–27.12, P =0.014). Conclusion: Surgical duration, hospital LOS, and total COA for 3-level ACDF operations are correlated with multiple baseline health factors that can be identified perioperatively. Awareness of modifiable factors can help guide added interventions to improve patient outcomes and increase the cost-value of the operation. Level of Evidence: Level III.