Multivariable Analysis of Factors Affecting Length of Stay and Hospital Charges After Atlantoaxial Fusion

BACKGROUND: Atlantoaxial fusion is an effective procedure for treating degenerative, traumatic, and congenital abnormalities that result in upper cervical instability; however, data on which factors affect the length of stay and hospitalization-related charges are limited. The purpose of this study was to evaluate the pre-, intra-, and postoperative variables that affect these healthcare cost factors for patients undergoing posterior atlantoaxial fusion. METHODS: We retrospectively identified from a clinical database 59 patients who underwent isolated posterior atlantoaxial fusion at a single institution from 2010 to 2015. Demographic, clinical, and surgical variables from a clinical database were analyzed with respect to the length of hospital stay and hospital charges. T-test and Chi-square testing, as well as univariate and multivariable analysis, were performed with p<0.05 considered significant. RESULTS: On multivariable analysis, a variety of preoperative, intraoperative, and postoperative variables were associated with prolonged hospitalization and higher hospital charges, including tobacco use, preoperative diagnosis, operating room time, and the need for intraoperative blood transfusion. CONCLUSIONS: Varied preoperative, intraoperative, and postoperative factors are associated with increased length of hospitalization and higher hospital charges after atlantoaxial fusion. Familiarity with these factors may allow for improved surgical planning and patient counseling.