Interaction of Preoperative Coagulopathy and Non-Elective Status in Association With Length of Stay for Patients Undergoing Lumbar Spinal Decompression Surgery.

Abstract

Study DesignRetrospective database analysis study.ObjectiveCoagulopathy, often defined as an International Normalized Ratio (INR) > 1.2, is associated with poor postoperative outcomes. We aimed to evaluate interactions between coagulopathy and non-elective surgery status regarding clinical outcomes among patients undergoing single-level lumbar decompression.MethodsData were obtained from the National Surgical Quality Improvement Program (2016-2021). Hierarchical regression models were used to evaluate associations between non-elective surgery and preoperative INR >1.2 with hospital length of stay (LOS) and home discharge. Effect modification of INR > 1.2 by non-elective surgery status and thrombocytopenia (platelet count < 150 k/mcL) was assessed. Random forest modeling simulated outcomes had coagulopathic patients presented with INR ≤ 1.2.ResultsAmong 34 591 patients (median age, 60 years), 8.5% underwent non-elective surgery and 1.8% had INR > 1.2. Non-elective surgery was associated with longer LOS (β = 3.4; <i>P</i> < 0.001) and reduced home discharge (OR, 0.20; <i>P</i> < 0.001). INR > 1.2 was also associated with prolonged LOS (β = 0.97; <i>P</i> < 0.001) and reduced home discharge (OR, 0.65; <i>P</i> < 0.001). Interactions for LOS were observed between INR >1.2 and both non-elective surgery (<i>P</i> < 0.001) and thrombocytopenia (<i>P</i> = 0.001). Simulated normalization of INR among non-elective surgery patients was associated with a reduction in LOS by a median of 2.5 days (IQR, 1.4-5.4 days decrease) and increase in home discharge by 17%.ConclusionsNon-elective surgery and preoperative INR > 1.2 were associated with prolonged LOS and lower odds of home discharge after single-level lumbar decompression. The effect of INR > 1.2 on LOS was more pronounced for non-elective cases and patients with thrombocytopenia.