What are the predictors of prolonged length of stay following single-stage lumbar fusion for grade 2 spondylolisthesis? A Spine CORe™ analysis of QOD data.
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2026-05
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Prolonged hospital length of stay (LOS) is an increasingly important quality metric among regulators and payers that has been associated with worse patient outcomes and decreased patient satisfaction. The aim of this study was to identify predictors of prolonged hospital LOS after surgery for Meyerding grade 2 spondylolisthesis using a multicenter prospectively collected registry. The prospectively collected Spine CORe™ Quality Outcomes Database (QOD) study group cohort, which consisted of 328 patients from 14 sites, was used to identify all patients who underwent single-stage lumbar fusion for Meyerding grade 2 lumbar spondylolisthesis. Prolonged LOS was defined as ≥ 4 days (75th percentile). An array of demographic, comorbidity, and perioperative factors known to impact LOS were collected for each patient. Bivariate tests, including the chi-square goodness of fit and independent t-test, were used to identify variables associated with prolonged LOS. Multivariable logistic regression analysis was conducted to determine independent predictors of prolonged LOS. The QOD cohort comprised 328 patients with a follow-up rate of > 80%. After excluding patients with an anterior or lateral surgical approach and missing LOS data, the final cohort included 268 patients, of whom 52 (19.4%) experienced a prolonged LOS. In the univariate analysis, older age, dependent ambulation, insurance status, depression, greater estimated blood loss, longer operative duration, multilevel fusion (2 or more levels), perioperative complications (e.g., incidental durotomy and urinary tract infection), and nonhome discharge were associated with prolonged LOS. In the adjusted model, multilevel arthrodesis independently increased the odds of prolonged LOS (OR 2.11, 95% CI 1.07-4.18; p = 0.03), whereas private insurance (vs Medicare/Medicaid/government) was associated with lower odds (OR 0.42, 95% CI 0.20-0.87; p = 0.02). Patient-reported outcomes at 60 months did not differ between the groups with and without prolonged LOS. In this multicenter Spine CORe™ QOD study, multilevel lumbar fusion and noncommercial insurance were the principal independent predictors of prolonged LOS after surgery for grade 2 spondylolisthesis. These findings are valuable for patient informed consent, as well as to identify higher-risk patients who could benefit from earlier inpatient resource allocation (social work and counseling) to facilitate timely discharge.
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White, Michael D, Izza Tahir, Maliya Delawan, Anthony L Asher, Paul K Kim, Kai-Ming G Fu, Michael S Virk, Christopher I Shaffrey, et al. (2026). What are the predictors of prolonged length of stay following single-stage lumbar fusion for grade 2 spondylolisthesis? A Spine CORe™ analysis of QOD data. Neurosurgical focus, 60(5). p. E17. 10.3171/2025.12.focus25958 Retrieved from https://hdl.handle.net/10161/34624.
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Scholars@Duke
Christopher Ignatius Shaffrey
I have more than 25 years of experience treating patients of all ages with spinal disorders. I have had an interest in the management of spinal disorders since starting my medical education. I performed residencies in both orthopaedic surgery and neurosurgery to gain a comprehensive understanding of the entire range of spinal disorders. My goal has been to find innovative ways to manage the range of spinal conditions, straightforward to complex. I have a focus on managing patients with complex spinal disorders. My patient evaluation and management philosophy is to provide engaged, compassionate care that focuses on providing the simplest and least aggressive treatment option for a particular condition. In many cases, non-operative treatment options exist to improve a patient’s symptoms. I have been actively engaged in clinical research to find the best ways to manage spinal disorders in order to achieve better results with fewer complications.
Oren N Gottfried
I specialize in the surgical management of all complex cervical, thoracic, lumbar, or sacral spinal diseases by using minimally invasive as well as standard approaches for arthritis or degenerative disease, deformity, tumors, and trauma. I have a special interest in the treatment of thoracolumbar deformities, occipital-cervical problems, and in helping patients with complex spinal issues from previously unsuccessful surgery or recurrent disease.I listen to my patients to understand their symptoms and experiences so I can provide them with the information and education they need to manage their disease. I make sure my patients understand their treatment options, and what will work best for their individual condition. I treat all my patients with care and concern – just as I would treat my family. I am available to address my patients' concerns before and after surgery. I aim to improve surgical outcomes for my patients and care of all spine patients with active research evaluating clinical and radiological results after spine surgery with multiple prospective databases. I am particularly interested in prevention of spinal deformity, infections, complications, and recurrent spinal disease. Also, I study whether patient specific variables including pelvic/sacral anatomy and sagittal spinal balance predict complications from spine surgery.
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