Surgical Delays and Their Implications on Inpatient Outcomes and Healthcare Resource Utilization: A Comprehensive Analysis in Patients with Ankylosing Spondylitis

Introduction: Surgical delays, influenced by factors like intraoperative complications and administrative bottlenecks, can significantly impact patient outcomes and healthcare resources. This study investigates if surgical delay independently predicts extended hospital stay, non-routine discharge, and increased hospital costs in AS patients.

Methods: A retrospective study was conducted using the National Inpatient Sample (NIS) database on adult patients with AS who underwent posterior spinal fusion for spinal fractures between 2016 and 2019. Patients were categorized based on whether they underwent surgical intervention within the first two days of admission (no surgical delay) or later (surgical delay). We collected data on patient demographics, hospital characteristics, comorbidity burden, operative characteristics, postoperative adverse events, and healthcare resource utilization. Multivariate logistic regression analyses were employed to determine if surgical delay is an independent predictor of extended length of stay, non-routine discharge, and increased total hospital cost.

Results: In the cohort of 1,980 patients, 53.8% had no procedure delay while 46.2% experienced a delay of ≥2 days. The delayed group was older (p < 0.001) and had higher Medicare coverage (78.6% vs 60.7%, p< 0.001). Comorbidity profiles differed significantly between the groups with higher prevalence of hypertension, complicated diabetes, GERD, deficiency anemias, history of CHF, and arrhythmia in the delayed group, who also had a significantly higher proportion of patients with ≥3 comorbidities. There was no significant difference in intraoperative variables. The delayed group had higher rates of multiple (≥2) adverse events and higher incidence of UTIs (13.1% vs. 6.1%, p=0.015). Postoperative outcomes revealed longer hospital stays and higher non-routine discharges in the delayed group (p < 0.001), with higher median costs (p=0.014). In multivariate regression analyses, surgical delay was not significantly associated with extended stay (p=0.062) or exorbitant cost (p=0.935) but was a significant predictor for non-routine discharge (p=0.015).

Conclusion : While surgical delay in patients with AS undergoing spinal surgery is linked to increased rates of non-routine discharges, longer hospital stays, and higher median admission costs, it was not independently predictive of extended stay or exorbitant hospital costs.