Predictors of Prolonged Surgical Duration and Hospital Length of Stay for 3-level Anterior Cervical Discectomy and Fusion

Introduction: Anterior cervical discectomy and fusion (ACDF) across three intervertebral levels can treat various multilevel spine pathologies, including degenerative disc disease and cervical myelopathy. Compared with single- and 2-level ACDF, 3-level ACDF is associated with extended surgical duration and hospital length of stay (LOS). We examined operating time and LOS predictors to identify patients at higher risk of increased surgical complexity, with the goal to provide them with additional perioperative care measures that can improve surgical outcomes.

Methods: Patients who underwent 3-level ACDF were retrospectively identified. Patient demographics, medical history, presenting symptoms, surgery characteristics, and postoperative outcomes were collected. Univariable analysis was conducted for each variable, with surgical duration and LOS as the primary outcomes of interest. Variables significant at p< 0.10 were subsequently incorporated in multivariable regression models for surgical duration and LOS.

Results: 137 patients were included in the cohort. The mean age was 59.1±11.3 years; 71 (51.8%) patients were male. The median (interquartile range) surgical duration and LOS were 211.5 (70.25) minutes and 2 (2) days, respectively. In the multivariable model, longer surgical duration was observed for male patients (β=36.61 min, 95% CI 7.41–65.80, p=0.014), Black patients (β=68.97 min, 95% CI 25.24–112.70, p=0.002), and total functional dependence (β=99.47 min, 95% CI 40.03–158.91, p=0.001). Longer hospital LOS was observed for Black patients (β=2.54 days, 95% CI 1.16–3.93, p< 0.001), Charlson Comorbidity Index (CCI) scores ≥ 2 (β=1.53 days, 95% CI 0.36–2.71, p=0.011), and total functional dependence (β=5.98 days, 95% CI 3.88–8.08, p< 0.001), while radiculopathy (β=-2.31 days, 95% CI -3.91– -0.71, p=0.005) was associated with shorter LOS.

Conclusion : Patient sex, race, and functional status are significantly associated with the surgical duration of 3-level ACDF, while patient race, CCI score, radiculopathy, and functional status are significantly associated with postoperative hospital LOS. Awareness of these factors can help identify patients who may benefit from added interventions such as Enhanced Recovery After Surgery, which can improve the standard of care and outcomes for patients undergoing 3-level ACDF.