Posterior Cervical Decompression and Fusion: Assessing Risk Factors for Nonhome Discharge and the Impact of Disposition on Postdischarge Outcomes

Discharge to Rehabilitation Predicts Increased Morbidity in Patients Undergoing Posterior Cervical Decompression and Fusion

“…In the present study and the aforementioned studies, rehabilitation-discharge independently predicted greater postdischarge morbidity, despite adequately controlling for patient frailty related factors. 17 The effectiveness of our multivariate analysis in controlling for patient-related factors is highlighted by our readmission results, particularly when comparing them to the results in Snyder et al 7 Specifically, our 30-day readmission rates were greater in the rehabilitation-discharge group in univariate analysis, but after controlling for patient-related factors, readmission, which is more specific to a patient's medical comorbidities than morbidity is, no longer statistically differed between groups. 14 In contrast to Snyder and colleagues, we found that 30-day readmission rates did not differ between home and rehabilitation-discharge groups.…”

“…This study is also unique in that predischarge and postdischarge morbidity rates were distinguished, which prior studies failed to do. 7 Our study revealed that, despite controlling for patient-related factors, procedural variables including levels fused, and other predictors of primary outcomes, discharge to rehabilitation independently predicted postdischarge morbidity, while 30-day readmission rates were statistically similar between groups.…”

“…[4][5][6] Of particular importance has been an emphasis on limiting overall health care costs by reducing 30-day readmission and postoperative morbidity. 2,[7][8][9] Postacute care has been found to be a significant driver of cost variation for spinal fusion, with reports showing up to 39% variation in payments made to hospitals. 10 There are no established clinical practice guidelines for postdischarge management of patients receiving spinal fusion surgery.…”

“…1 Recently, studies have focused on evaluating discharge disposition as a potential way to maximize 30-day outcomes, with considerable variance in outcomes depending on the type of spine surgery being performed. 1,7,[10][11][12] Cook and colleagues previously evaluated the impact of discharge disposition on 30-day outcomes for PCDF, but neither excluded patients with posterior cervical decompression without fusion nor distinguished between predischarge and postdischarge morbidity. 7 Understanding the association between rehabilitation-based discharge destinations, hospital readmissions, and baseline patient-related risk factors may call into attention the optimization of discharge planning for patients following PCDF and the further evaluation of postacute care options.…”

“…1,7,[10][11][12] Cook and colleagues previously evaluated the impact of discharge disposition on 30-day outcomes for PCDF, but neither excluded patients with posterior cervical decompression without fusion nor distinguished between predischarge and postdischarge morbidity. 7 Understanding the association between rehabilitation-based discharge destinations, hospital readmissions, and baseline patient-related risk factors may call into attention the optimization of discharge planning for patients following PCDF and the further evaluation of postacute care options. 1 It is increasingly important for hospital to understand readmission patterns and risk factors, and to implement strategies directed at high-risk patients.…”