Influence of hospital size on postoperative outcomes, length of stay, and costs following single-level cervical disc arthroplasty.

BACKGROUND

Hospital size has been shown to influence resource availability, staffing, and patient care quality. This study aims to evaluate the impact of hospital size on postoperative outcomes such as length of stay (LOS), total costs, complications, and non-routine discharge rates in patients undergoing single-level CDA.

METHODS

The National Inpatient Sample (NIS) was queried to identify 14,315 weighted cases of patients who underwent single-level CDA between 2016 and 2020. Patients undergoing single-level CDA were stratified by hospital size (small, medium, large). Chi-square and ANOVA tests were used to compare demographic variables and outcomes across hospital sizes. Ridge regression was employed to analyze the relationship between perioperative complications and non-routine discharge across hospital sizes. Statistical significance was set at the 0.05 level.

RESULTS

Patients treated in smaller hospitals were younger than those in medium and large hospitals (46.9 vs. 48.4 and 48.0 years,  = 0.036). LOS was shorter in small hospitals compared to medium and large-sized hospitals (1.30 vs. 1.45 vs. 1.45 days,  = 0.048). Medium hospitals had a higher rate of non-routine discharges (9.3 %) compared to small (5.3 %) and large hospitals (6.2 %,  = 0.004). Cardiovascular complications were predictive of non-routine discharge in large hospitals (OR = 2.31,  = 0.048), while surgical complications were significant in medium hospitals (OR = 2.00,  = 0.010).

CONCLUSION

Medium hospitals demonstrated longer LOS and higher non-routine discharge rates, likely due to resource limitations. Enhancing staffing and care coordination may improve outcomes across hospital settings.