Impact of elective versus emergent admission on perioperative complications and resource utilization in lumbar fusion

Background: The notion of higher complication rate and mortality in emergency surgeries is well established. There is a paucity of literature demonstrating the impact of emergent versus elective admissions for spinal surgery on the perioperative outcomes. We aim to evaluate the influence of the type of admission (elective or emergent) and day of surgery (same day versus other days within the emergent group) on the incidence, pattern of perioperative complications and hospital charges in the patients undergoing lumbar fusion for degenerative spine disease.

Methods: Data was obtained from the Nationwide Inpatient Sample (NIS) database between 2002 and 2011. We performed multivariate analysis to evaluate the impact of admission type and day of surgery on perioperative outcomes.

Results: A total of 266439 patients were identified. The majority of the admissions were elective (92.6%). Emergent admission comprised 7.4% of the total admission. Mean Charlson comorbidity index (CCI) was significantly higher in emergent and 'other days' (<0.001) groups. Emergent admission and surgery performed on the 'other days' were the independent risk factors for the higher incidence of the venous thromboembolic events, surgical site infection and wound dehiscence. The patients in the emergent and 'other days' surgery groups had a longer stay in the hospital (P<0.001). The mean total hospital charges were higher in the emergent admission and 'other days' surgery groups (P<0.001).

Conclusions: 'Emergent admission' and surgery performed on the 'other days' in lumbar fusion are independent risk factors for the higher incidence of perioperative complications. Complicated hospital course and longer stay of the patients in the emergent admission and 'other days' group seems to be associated with higher total hospital charges.