• Emily K Chapman, Tahera Doctor, Jonathan S Gal, Michael L Martini, William H Shuman, Sean N Neifert, Jeffrey T Gilligan, Frank J Yuk, Jeffrey H Zimering, Alexander J Schupper, and John M Caridi.
• Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA. Electronic address: emily.chapman@icahn.mssm.edu.
• World Neurosurg. 2021 Jun 1; 150: e38-e44.

ObjectiveWe sought to compare the cost and in-hospital outcomes following lumbar microdiskectomy procedures by admission type.MethodsPatients undergoing lumbar microdiskectomy at a single institution from 2008 to 2016 following an elective admission (EL) were compared against those who were admitted from the emergency department (ED) or from elsewhere within or outside the hospital system (TR) for their perioperative outcomes and cost. Multivariable modeling controlled for age, sex, self-reported race, Elixhauser comorbidity score, payer type, number of segments, and procedure length.ResultsOf the 1249 patients included in this study, 1116 (89.4%) were admitted electively while 123 (9.8%) were admitted from the ED and 10 (0.8%) were transferred from other hospitals. EL patients had significantly lower comorbidity burdens (P < 0.0001). Univariate and multivariable analyses revealed that transfer admission patients experienced significantly longer hospitalizations (ED: +1.7 days; P < 0.0001; TR: +5.3 days; P < 0.0001) and higher direct costs (ED: $1889; P < 0.0001; TR: $7001; P < 0.0001) compared with EL patients. Despite these risks, ED and TR patients only had increased odds of nonhome discharge compared with EL patients (ED: 3.4; P = 0.002; TR: 7.9; P = 0.02).ConclusionsPatients admitted as transfers and from the ED had significantly increased hospitalization lengths of stay and direct costs compared with electively admitted patients.Copyright © 2021 Elsevier Inc. All rights reserved.

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