Discharge Disposition and Clinical Outcomes After Spine Surgery

Abstract

Objective: Spinal decompression with or without fusion is one of the most commonly performed procedures in spine surgery. However, there is limited evidence on the effect of discharge environment on outcomes after surgery. The purpose of this study is to identify the effects of discharge disposition setting on clinical outcomes after spine surgery. Methods: Patients who underwent lumbar decompression, lumbar decompression and fusion, or posterior cervical decompression and fusion surgery were retrospectively identified. All clinical and demographic data were obtained from electronic health records. Surgical outcomes included wound complications, revision surgery, “30-day” readmission (0–30 d), and “90-day” readmission (31–90 d). Discharge disposition was stratified into home/self-care, acute inpatient rehabilitation, and subacute rehabilitation. Patient-reported outcome measures including VAS Back, VAS Leg, VAS Neck, VAS Arm, PCS-12 and MCS-12, ODI, and NDI were compared between patient discharge disposition settings using the Mann–Whitney U test. Pearson’s chi-square analysis was used to assess for differences in wound complications, revision surgery, 30-day readmission, or 90-day readmission rates. Multivariate logistic regression incorporating age, sex, body mass index (BMI), Charlson Comorbidity Index (CCI), and discharge disposition was used to determine independent predictors of wound complications. Results: A total of 637 patients were included in the study. A significant difference (P = 0.03) was found in wound complication based on discharge disposition, with subacute disposition having the highest proportion of wound complications (6.1%) and home disposition having the lowest (1.5%). There were no significant differences in the rates of revision surgery, 30-day readmission, or 90-day readmission between groups. Subacute rehabilitation (odds ratio: 3.67, P = 0.047) and CCI (odds ratio 1.49, P = 0.01) were independent predictors of wound complications. Significant improvement in PROMs was seen across all postacute discharge dispositions. Baseline (P = 0.02) and postoperative (P = 0.02) ODI were significantly higher among patients discharged to an acute facility (49.4 and 32.0, respectively) compared to home (42.2 and 20.0) or subacute (47.4 and 28.4) environments. Conclusion: Subacute rehabilitation disposition and CCI are independent predictors of wound complications after spinal decompression surgery. Patients undergoing spine surgery have similar readmission and revision rates and experience similar clinical improvement across all postacute discharge dispositions.

AOA Critical Issues: Patient-Reported Outcome Measures

“…Patients discharged home were found to have significantly higher preoperative functional scores 40 . Similar studies found lower PROM scores for those discharged to post-acute rehabilitation facilities 41-43 . By implementing preoperative PROMs, orthopaedic surgeons can identify patients who are not yet ideal candidates for an elective procedure if the goal is for discharge home.…”

Neighborhood-level socioeconomic status, extended length of stay, and discharge disposition following elective lumbar spine surgery

“…While not the principal investigation of the present analyses, we found that patients discharged to healthcare facilities were less likely to be readmitted or re-present to the hospital following elective lumbar spine surgery. Prior research has reported similar observations following spine surgery, [54] although other studies have reported no association between discharge disposition and hospital readmission risk [ 52 , 55 ].…”

The Rehabilitation-Related Effects on the Fear, Pain, and Disability of Patients With Lumbar Fusion Surgery: A Systematic Review and Meta-Analysis

“…In the recent study, the rehabilitation might play a role as an independent predictor for the wound complications after lumbar fusion surgery. 36 Even the current metaanalysis did not survey the wound complications, the improvement of disability and pain might be related to the factor. However, a recent study reported that discharged to rehabilitation and discharged to home showed a statistically similar postdiswww.e-neurospine.org 287 charge morbidity status.…”