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Gabriel A. Smith, Steven Chirieleison, Jay Levin, Karam Atli, Robert Winkelman, Joseph E. Tanenbaum, Thomas Mroz, and Michael Steinmetz

–21 As established by the CMS, reimbursement to hospitals and providers under the Inpatient Prospective Payment System is initially set at a flat rate. This rate is tied to the care provided through the use of the Medicare Severity Diagnosis Related Groups (MS-DRGs). A key component of this reimbursement process is the inpatient length of stay (LOS) expected for any MS-DRG. While adjustments to the MS-DRG payment rate are made for comorbidities and case complexity, patient LOS for a given MS-DRG remains a critical quality metric directly affecting operational costs and

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Daniel A. Carr, Rajiv Saigal, Fangyi Zhang, Richard J. Bransford, Carlo Bellabarba, and Armagan Dagal

analgesia have led to a decrease in hospital length of stay (HLOS) of 1.3 to 2 days and a 22% decrease in hospital charges. 7 , 18 However, another study demonstrated that intraoperative variables such as implant and bone graft choices may influence cost more than an accelerated discharge program. 17 Individual elements of ERAS such as intravenous acetaminophen have shown cost reduction in spine surgery. 9 Standardization of preoperative medical assessment and optimization of patients allows preparation from a psychological and physical standpoint and may reduce

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Tsinsue Chen, Zaman Mirzadeh, Kristina Chapple, Margaret Lambert, and Francisco A. Ponce

gained popularity in the past several years. 1 , 8 , 21 , 30 , 34 As published reports on functional outcomes of asleep DBS increase, 2 , 8 , 27 , 30 , 31 , 39 the question of whether there is a difference in how patients tolerate the procedure becomes pertinent. In particular, factors such as extended time under general anesthesia may influence perioperative outcomes in this population. However, no large studies have reported complication rates for asleep DBS, and relatively few series have analyzed length of stay (LOS) and readmission rates. As surgical techniques

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Matthew C. Davis, Elizabeth N. Kuhn, Bonita S. Agee, Robert A. Oster, and James M. Markert

increased postoperative complications and hospital charges in neurosurgical patients, with no improvement in outcomes. 7 , 8 , 21 , 32 Additionally, the ACGME mandates that residents have a minimum break period between shifts, which necessitates an increased frequency of handoffs and fragments continuity of care. 24 The influence of a night float system on patient outcomes in neurosurgery has never been rigorously evaluated. Here, we compare hospital and neurosurgical ICU lengths of stay (LOSs) for neurosurgical patients admitted before and after initiation of a night

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Narayana Varhabhatla and Zhiyi Zuo

, : Pulmonary function before and after abdominal surgery in the aged . Jpn J Surg 11 : 73 – 79 , 1981 10 Kong GK , Belman MJ , Weingarten S : Reducing length of stay for patients hospitalized with exacerbation of COPD by using a practice guideline . Chest 111 : 89 – 94 , 1997 11 National Heart Lung, and Blood Institute, National Institutes of Health : Morbidity and Mortality Chartbook Bethesda, MD , National Heart, Lung, and Blood Institute , 2004 12 Rabe KF , Hurd S , Anzueto A , Barnes PJ , Buist SA , Calverley P , : Global

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Aladine A. Elsamadicy, Andrew B. Koo, Adam J. Kundishora, Fouad Chouairi, Megan Lee, Astrid C. Hengartner, Joaquin Camara-Quintana, Kristopher T. Kahle, and Michael L. DiLuna

I n the past decade, there has been a dramatic transition from the traditional fee-for-service model to value-based care; it is reflected in an increased health policy emphasis on outcomes-based payment strategies and conservative use of resources for both hospitals and physicians. 16 , 21 In surgery, length of stay (LOS) has increasingly become a proxy of overall value and quality of care performed by hospitals. 13 Therefore, there has been an increased national effort in recognizing patients with extended LOS to help identify modifiable risk factors that may

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Siddhartha Singh, Rodney Sparapani, and Marjorie C. Wang

readmissions. The purpose of this study was to evaluate the role of physicians, and specifically spine surgeons, in readmission rates after elective lumbar spine surgery for degenerative conditions in a national study of US Medicare beneficiaries. Because variations in length of stay (LOS) have been shown to be associated with surgeon practice patterns in other populations, we also evaluated the variation in LOS in the same Medicare cohort. 15 Methods Study Population and Data Source Medicare claims were provided by CMS, including Medicare Provider Analysis and Review

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Scott L. Zuckerman, Clinton J. Devin, Vincent Rossi, Silky Chotai, E. Hunter Dyer, John J. Knightly, Eric A. Potts, Kevin T. Foley, Erica F. Bisson, Steven D. Glassman, Praveen V. Mummaneni, Mohamad Bydon, and Anthony L. Asher

approximately 67% of neurosurgical practice. 9 Total spine costs exceed $200 billion, 10 and the greatest proportion of overall healthcare expenditure in US hospitals is spent on spinal fusion. 11 While outcomes achieved with surgery are excellent at a group level, tremendous individual variation exists regarding length of stay (LOS) and readmission, leaving significant room for improvement. 3 While some centers have described streamlined clinical care pathways and multidisciplinary QI initiatives, these have generally been single-institution experiences comprising smaller

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Sebastian Salas-Vega, Vikram B. Chakravarthy, Robert D. Winkelman, Matthew M. Grabowski, Ghaith Habboub, Jason W. Savage, Michael P. Steinmetz, and Thomas E. Mroz

S urgeries account for a significant proportion of overall US healthcare expenditures. The total costs per hospitalization have risen with costs per inpatient day, 1 and surgical admissions now account for 49% of all inpatient spending. 2 , 3 As the healthcare system rapidly evolves in an attempt to manage escalating expenditures and an ever-growing demand, efforts to reduce unnecessarily long hospital lengths of stay (LOSs) may help lower surgical costs and lessen burdens on providers and patients. Toward this end, recent policy reforms have focused

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Sanjay Yadla, George M. Ghobrial, Peter G. Campbell, Mitchell G. Maltenfort, James S. Harrop, John K. Ratliff, and Ashwini D. Sharan

relationship between prolonged hospital stay and costs in several arenas including general surgery, urological procedures, and cardiac interventions. 12 , 13 , 14 , 17 These reports have demonstrated the direct relationship between length of stay (LOS) and increasing expenditures. We hypothesized that certain complications have a greater impact on LOS than others. Identification of these specific complications might provide a rationale for focused prevention efforts by health care providers in the future. To test this hypothesis, we retrospectively analyzed a prospectively