The potential risk factors for prolonged length of stay despite an enhanced recovery after surgery protocol for elder patients undergoing short-level lumbar fusion surgery

Objective: To identify the risk factors associated with prolonged length of stay (LOS) despite an enhanced recovery after surgery (ERAS) protocol in short-level lumbar fusion surgery. Methods ERAS was implemented maturely at our department in January 2019. We gathered data for all patients undergoing short-level lumbar fusion surgery from May to November 2021. Given the discharge criterias, a threshold was set according to mean LOS, and two groups were spontaneously formed: LOS shorter than the threshold for discharge (Group 1, n = 114) and LOS longer or equal to the threshold for discharge (Group 2, n = 72). Preoperative metrics were compared to identify risk factors associated with prolonged LOS. Results A total consecutive 186 patients with complete medical records were enrolled (77 males and 109 females; mean age 71.08 ± 5.70 years). After dichotomization according to the threshold for discharge, there were 114 patients in Group 1 and 72 in Group 2. Statistical analysis demonstrated that age ≥ 75 years (p = 0.002), female sex (p < 0.001), American Society of Anesthesiologists grade ≥ 3 (p = 0.035), operation time (p < 0.001), anesthesia time (p  1 day (p = 0.027), removal of urinary catheter time > 1 day (p = 0.019), fusion levels (p  1 (p < 0.001) and allogenetic transfusion (p = 0.009) were significantly related to prolonged LOS. Binary logistic regression revealed that age (odds ratio (OR) 5.149; 95% confidence interval (CI) 2.045–12.966, p = 0.001), sex (OR 5.185, 95% CI 2.183–12.317, p  1(OR 15.936, 95% CI 5.220–48.652, p < 0.001) were independent risk factors of prolonged LOS. Conclusions In this retrospective study, we analysed the potential risk factors associated with delayed LOS despite implementing ERAS, further, binary logistic regression exhibited that age ≥ 75 years old, female sex and Clavien-Dindo grade > 1 were independently correlated with prolonged LOS.