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J Neurosurg Spine. 2019 Dec 6:1-10. doi: 10.3171/2019.9.SPINE19644. [Epub ahead of print]

Predictors of nonroutine discharge among patients undergoing surgery for grade I spondylolisthesis: insights from the Quality Outcomes Database.

Author information

1
1Department of Neurological Surgery, University of California, San Francisco, California.
2
2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.
3
3Atlantic Neurosurgical Specialists, Morristown, New Jersey.
4
4Department of Neurological Surgery, University of Utah, Salt Lake City, Utah.
5
5Norton Leatherman Spine Center, Louisville, Kentucky.
6
6Department of Neurosurgery, University of Tennessee, Memphis, Tennessee.
7
7Geisinger Health System, Danville, Pennsylvania.
8
8Department of Neurological Surgery, Indiana University, Goodman Campbell Brain and Spine, Indianapolis, Indiana.
9
9Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia.
10
10Departments of Neurological Surgery and Orthopedic Surgery, Duke University, Durham, North Carolina.
11
11Department of Neurological Surgery, Weill Cornell Medical College, New York, New York.
12
12Department of Neurologic Surgery, University of Michigan, Ann Arbor, Michigan.
13
13Department of Neurologic Surgery, University of Miami, Florida; and.
14
14Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina.

Abstract

OBJECTIVE:

Discharge to an inpatient rehabilitation facility or another acute-care facility not only constitutes a postoperative challenge for patients and their care team but also contributes significantly to healthcare costs. In this era of changing dynamics of healthcare payment models in which cost overruns are being increasingly shifted to surgeons and hospitals, it is important to better understand outcomes such as discharge disposition. In the current article, the authors sought to develop a predictive model for factors associated with nonroutine discharge after surgery for grade I spondylolisthesis.

METHODS:

The authors queried the Quality Outcomes Database for patients with grade I lumbar degenerative spondylolisthesis who underwent a surgical intervention between July 2014 and June 2016. Only those patients enrolled in a multisite study investigating the impact of fusion on clinical and patient-reported outcomes among patients with grade I spondylolisthesis were evaluated. Nonroutine discharge was defined as those who were discharged to a postacute or nonacute-care setting in the same hospital or transferred to another acute-care facility.

RESULTS:

Of the 608 patients eligible for inclusion, 9.4% (n = 57) had a nonroutine discharge (8.7%, n = 53 discharged to inpatient postacute or nonacute care in the same hospital and 0.7%, n = 4 transferred to another acute-care facility). Compared to patients who were discharged to home, patients who had a nonroutine discharge were more likely to have diabetes (26.3%, n = 15 vs 15.7%, n = 86, p = 0.039); impaired ambulation (26.3%, n = 15 vs 10.2%, n = 56, p < 0.001); higher Oswestry Disability Index at baseline (51 [IQR 42-62.12] vs 46 [IQR 34.4-58], p = 0.014); lower EuroQol-5D scores (0.437 [IQR 0.308-0.708] vs 0.597 [IQR 0.358-0.708], p = 0.010); higher American Society of Anesthesiologists score (3 or 4: 63.2%, n = 36 vs 36.7%, n = 201, p = 0.002); and longer length of stay (4 days [IQR 3-5] vs 2 days [IQR 1-3], p < 0.001); and were more likely to suffer a complication (14%, n = 8 vs 5.6%, n = 31, p = 0.014). On multivariable logistic regression, factors found to be independently associated with higher odds of nonroutine discharge included older age (interquartile OR 9.14, 95% CI 3.79-22.1, p < 0.001), higher body mass index (interquartile OR 2.04, 95% CI 1.31-3.25, p < 0.001), presence of depression (OR 4.28, 95% CI 1.96-9.35, p < 0.001), fusion surgery compared with decompression alone (OR 1.3, 95% CI 1.1-1.6, p < 0.001), and any complication (OR 3.9, 95% CI 1.4-10.9, p < 0.001).

CONCLUSIONS:

In this multisite study of a defined cohort of patients undergoing surgery for grade I spondylolisthesis, factors associated with higher odds of nonroutine discharge included older age, higher body mass index, presence of depression, and occurrence of any complication.

KEYWORDS:

ASA = American Society of Anesthesiologists; AUC = area under the curve; BMI = body mass index; EQ-5D = EuroQol-5D; IQR = interquartile range; NRS = numeric rating scale; ODI = Oswestry Disability Index; PRO = patient-reported outcome; QOD; QOD = Quality Outcomes Database; Quality Outcomes Database; SNF = skilled nursing facility; discharge disposition; lumbar spine; nonroutine discharge; spine surgery; spondylolisthesis

PMID:
31812142
DOI:
10.3171/2019.9.SPINE19644

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