Patient, clinical, surgical, and institutional factors associated with length of stay in scheduled degenerative thoracolumbar spine surgery: National Multicenter Cohort Analysis from the Canadian Spine Outcomes and Research Network.

OBJECTIVE: Length of stay (LOS) is a contributor to costs and resource utilization. The primary goal of this study was to identify patient, clinical, surgical, and institutional variables that influence LOS after elective surgery for thoracolumbar degenerative pathology. The secondary objective was to examine variability in LOS and institutional strategies used to decrease LOS. METHODS: This is a retrospective study of prospectively collected data from a multicentric cohort enrolled in the Canadian Spine Outcomes and Research Network (CSORN) between January 2015 and October 2020 who underwent elective thoracolumbar surgery (discectomy [1 or 2 levels], laminectomy [1 or 2 levels], and posterior instrumented fusion [up to 5 levels]). Prolonged LOS was defined as LOS greater than the median. Logistic regression models were used to determine factors associated with prolonged LOS for each procedure. A survey was sent to the principal investigators of the participating healthcare institutions to understand institutional practices that are used to decrease LOS. RESULTS: A total of 3700 patients were included (967 discectomies, 1094 laminectomies, and 1639 fusions). The median LOSs for discectomy, laminectomy, and fusion were 0.0 (IQR 1.0), 1.0 (IQR 2.0), and 4.0 (IQR 2.0) days, respectively. On multivariable analysis, predictors of prolonged LOS for discectomy were having more leg pain, higher Oswestry Disability Index (ODI) scores, symptom duration more than 2 years, having undergone an open procedure, occurrence of an adverse event (AE), and treatment at an institution without protocols to reduce LOS (p < 0.05). Predictors of prolonged LOS for laminectomy were increased age, living alone, higher ODI scores, higher BMI, open procedures, longer operative time, AEs, and treatment at an institution without protocols to reduce LOS (p < 0.05). For posterior instrumented fusion, predictors of prolonged LOS were older age, living alone, more comorbidities, higher ODI scores, longer operative time, AEs, and treatment at an institution without protocols to reduce LOS (p < 0.05). The laminectomy group had the largest variability in LOS (SD 4.4 days, range 0-133 days). Three hundred fifty-four patients (22%) had an LOS above the 75th percentile. Ten institutions (53%) had either Enhanced Recovery After Surgery or standardized protocols in place. CONCLUSIONS: Among the factors identified in this study, worse baseline ODI scores, experiencing AEs, and treatment at an institution without protocols aimed at reducing LOS were predictive of prolonged LOS in all surgical groups. The laminectomy group had the largest variability in LOS.

Two-dimensional Bose gases near resonance: competing two-body and three-body effects.

We report in this Letter the results of our investigation of 2D Bose gases beyond the dilute limit emphasizing the role played by three-body scattering events. We demonstrate that a competition between three-body attractive interactions and two-body repulsive forces results in the chemical potential of 2D Bose gases to exhibit a maximum at a critical scattering length beyond which these quantum gases possess a negative compressibility. For larger scattering lengths, the increasingly prominent role played by three-body attractive interactions leads to an onset instability at a second critical value. The three-body effects studied here are universal, fully characterized by the effective 2D scattering length a(2D) (or the size of the 2D bound states) and are, in comparison to the 3D case, independent of three-body ultraviolet physics. We find, within our approach, the ratios of the contribution to the chemical potential due to three-body interactions to the one due to two-body to be 0.27 near the maximum of the chemical potential and 0.73 in the vicinity of the onset instability.

Fermi-Bose mixtures near broad interspecies Feshbach resonances.

In this Letter we study dressed bound states in Fermi-Bose mixtures near broad interspecies resonances, and implications on many-body correlations. We present the evidence for a first order phase transition between a mixture of Fermi gas and condensate, and a fully paired mixture where extended fermionic molecules occupy a single pairing channel instead of forming a molecular Fermi surface. We further investigate the effect of Fermi surface dynamics and pair fluctuations and discuss the validity of our results.