Evaluating factors affecting length of hospital stay in patients with metastatic bone tumors

Specific medical conditions known to increase LOS following orthopedic surgery including congestive heart failure, diabetes mellitus and COPD. It is also known that patient demographics such as increasing age and non-white race can negatively affect orthopedic surgical outcomes However, there is a lack of research examining the effect of these variables on patients with metastatic bone disease regarding length of hospital stay and ultimately economic burden following surgery. The aim of this study is to identify factors affecting LOS in patients following surgery for bone metastasis.

A retrospective chart review was used to extract data from 93 patients with an underlying diagnosis of bony metastatic cancer who underwent an orthopedic surgical procedure. Data collected included: length of hospital stay, demographic information (age, sex, race, BMI, smoking status), complications (infection, DVT, PE, fractures), pre-operative lab values (WBC, Albumin, Creatinine, HbA1c), primary cancer type, and surgical procedure measures to understand which factors affected LOS.

Increased LOS in this specific patient population was found to be associated with pre-existing diabetes (P = 0.005), obesity (P = 0.025), multiple disease sites (P = 0.042), or disease at the femur (P = 0.035). Patients had a decreased LOS when undergoing a prophylactic procedure (3.53 days vs 5.51 days for non-prophylactic procedure).

These findings allow providers to better communicate expectations regarding the duration of admission and allows for a better estimation of cost burden for patients and health systems. The present study demonstrates increased LOS in patients undergoing orthopedic procedures for metastatic bone disease who had pre-existing diabetes, obesity, multiple disease sites, disease in the femur, or surgery for a pathologic fracture (as opposed to a prophylactic procedure). Understanding the factors affecting LOS in this patient population can optimize preoperative care, improve communication between the patient and provider, and ultimately decrease financial burden.