Predictors of adverse discharge disposition in adult spinal deformity and associated costs

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

“…Given the high costs of SNF and acute rehabilitation facilities, [ 4 , 56 ] coupled with the increase in spine surgery incidence, [8] understanding the cost-benefit analysis of utilizing medical facilities following discharge is particularly salient as healthcare expenditure continues to rise [57] . A 2014 Cochrane systematic review concluded that more evidence in the form of randomized control trials to assess the utility of rehabilitation following lumbar disc herniation is needed [58] .…”

“…As pay-for-performance and bundled care reimbursement structures become more prevalent, health systems face increasing financial pressure to deliver high quality care more efficiently and cost effectively [ 1 , 2 ]. Extended length of stay (LOS) and non-home discharges are associated with significant healthcare costs [ 3 , 4 ]. However, a small percentage of patients contribute to the majority of these costs—roughly 10% of patients contribute to 63% of all US healthcare expenditures [ 5 , 6 ].…”

“…Prior research has identified patient age, baseline functional status, governmental forms of insurance, procedure duration, and surgical complications as risk factors for prolonged LOS and resource intensive discharges [ 4 , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] ]. However, these studies were largely performed on national databases which only provide coarse estimates of socioeconomic status (SES) through variables such as age, gender, race, and insurance status [ 9 , [12] , [13] , [14] , [17] , [18] , [19] , [20] ].…”

“…One metric of area-level social determinants of health is Area of Deprivation index (ADI), a composite measure of income, education, employment, and housing quality [22] , [23] , [24] . Patients with an extended LOS and non-home discharges disproportionately contribute to costs of care [ 3 , 4 , 25 ], and thus recognizing these patients is critical.…”

Quality and Safety Improvement in Spine Surgery

“…22,[96][97][98][99][100] With the rise of contemporary value-based bundled health care models, interest in cost improvement strategies that do not compromise the quality of care have also led to the development of predictive models to estimate prolonged hospital stay and adverse discharge destination for elective spine surgery. [101][102][103][104][105][106][107][108][109] The impact of predictive models on the practice of modern medicine is enormous. Whether consciously or subconsciously, clinicians and surgeons risk stratify patients encountered in clinical practice based on their previous training and experiences.…”