Authors: Samer Zammar, MD; Brian Anderson; George Reiter, MD; Abraham Schlauderaff, MD (Hershey, PA)


Single level lumbar fusion is a procedure associated with relatively narrow set of indications. It requires multiple surgical steps and exploits the use of implanted hardware. The patient usually requires an inpatient stay and utilizes multiple hospital services including radiology, physical therapy and rehabilitation medicine. The authors implemented a new perioperative pathway for these patients in an attempt to decrease the length of stay (LOS) of patients undergoing single level lumbar fusion.


 Data collected from Time-Driven Activity-Based Costing was used to develop a multidisciplinary perioperative pathway with an aim to optimize the stay for our single level spinal fusion patients. The pathway involved changes in the consent process, the review of usual hospital course, and setting patients expectation in the pre-op visit. On an inpatient level, the process engaged the surgery, immediate post-op care, pain medications, and rehabilitation evaluation. Finally, the pathway involved the outpatient therapy and rehab stay in the postoperative setting.  The authors compared patient populations before and after the implementation of this new protocol. The primary outcome was the LOS and the secondary outcome was the cost changes.


The average LOS of patients decreased significantly from 4.1 days to 3.2 days  and there was an average of $1,271 cost savings per case after the care pathway was implemented. The total reduced cost from the new LOS was $121K. The new contribution margin from additional capacity was $728K. This resulted in an overall cost reduction to $849K.


The new implemented multidisciplinary perioperative pathway significantly decreased the LOS  and the total costs for patients with single level lumbar fusion without affecting the quality of care. This new pathway merits the discussion in other surgical indications due to its potential beneficial effects to the patient and the hospital.

Robert Florin Award