• Joseph R Linzey, Rachel Foshee, Francine Moriguchi, Arjun R Adapa, Sravanthi Koduri, Elyne N Kahn, Craig A Williamson, Kyle Sheehan, Venkatakrishna Rajajee, B Gregory Thompson, Karin M Muraszko, and Aditya S Pandey.
• Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan.
• Neurosurgery. 2021 Feb 16; 88 (3): E259-E264.

BackgroundLength of stay beyond medical readiness (LOS-BMR) leads to increased expenses and higher morbidity related to hospital-acquired conditions.ObjectiveTo determine the proportion of admitted neurosurgical patients who have LOS-BMR and associated risk factors and costs.MethodsWe performed a prospective, cohort analysis of all neurosurgical patients admitted to our institution over 5 mo. LOS-BMR was assessed daily by the attending neurosurgeon and neuro-intensivist with a standardized criterion. Univariate and multivariate logistic regressions were performed.ResultsOf the 884 patients admitted, 229 (25.9%) had a LOS-BMR. The average LOS-BMR was 2.7 ± 3.1 d at an average daily cost of $9 148.28 ± $12 983.10, which resulted in a total cost of $2 076 659.32 over the 5-mo period. Patients with LOS-BMR were significantly more likely to be older and to have hemiplegia, dementia, liver disease, renal disease, and diabetes mellitus. Patients with a LOS-BMR were significantly more likely to be discharged to a subacute rehabilitation/skilled nursing facility (40.2% vs 4.1%) or an acute/inpatient rehabilitation facility (22.7% vs 1.7%, P < .0001). Patients with Medicare insurance were more likely to have a LOS-BMR, whereas patients with private insurance were less likely (P = .048).ConclusionThe most common reason for LOS-BMR was inefficient discharge of patients to rehabilitation and nursing facilities secondary to unavailability of beds at discharge locations, insurance clearance delays, and family-related issues.© Congress of Neurological Surgeons 2020.

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