Indicators for nonroutine discharge following cervical deformity-corrective surgery: Radiographic, surgical, and patient-related factors

Cole A. Bortz, Peter G. Passias, Frank Segreto, Samantha R. Horn, Virginie Lafage, Justin S. Smith, Breton Line, Gregory M. Mundis, Khaled M Kebaish, Michael P. Kelly, Themistocles Protopsaltis, Daniel Sciubba, Alexandra Soroceanu, Eric O. Klineberg, Douglas C. Burton, Robert A. Hart, Frank J. Schwab, Shay Bess, Christopher I. Shaffrey, Christopher P. Ames

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Nonroutine discharge, including discharge to inpatient rehab and skilled nursing facilities, is associated with increased cost-of-care. Given the rising prevalence of cervical deformity (CD)-corrective surgery and the necessity of value-based healthcare, it is important to identify indicators for nonroutine discharge. OBJECTIVE: To identify factors associated with nonroutine discharge after CD-corrective surgery using a statistical learning algorithm. METHODS: A retrospective review of patients ≥18 yr with discharge and baseline (BL) radiographic data. Conditional inference decision trees identified factors associated with nonroutine discharge and cut-off points at which factors were significantly associated with discharge status. A conditional variable importance table used nonreplacement sampling set of 10 000 conditional inference trees to identify influential patient/surgical factors. The binary logistic regression indicated odds of nonroutine discharge for patients with influential factors at significant cut-off points. RESULTS: Of 138 patients (61 yr, 63% female) undergoing surgery for CD (8 ± 5 levels; 49% posterior approach, 16% anterior, and 35% combined), 29% experienced nonroutine discharge. BL cervical/upper-cervical malalignment showed the strongest relationship with nonroutine discharge: C1 slope ≥ 14°, C2 slope ≥ 57°, TS-CL ≥ 57°. Patient-related factors associated with nonroutine discharge included BL gait impairment, age ≥ 59 yr and apex of CD primary driver ≥ C7. The only surgical factor associated with nonroutine discharge was fusion ≥ 8 levels. There was no relationship between nonhome discharge and reoperation within 6 mo or 1 yr (both P >. 05) of index procedure. Despite no differences in BL EQ-5D (P =. 946), nonroutine discharge patients had inferior 1-yr postoperative EQ-5D scores (P =. 044). CONCLUSION: Severe preoperative cervical malalignment was strongly associated with nonroutine discharge following CD-corrective surgery. Age, deformity driver, and ≥ 8 level fusions were also associated with nonroutine discharge and should be taken into account to improve patient counseling and health care resource allocation.

Original languageEnglish (US)
Article numbernyz016
Pages (from-to)E509-E519
JournalClinical Neurosurgery
Volume85
Issue number3
DOIs
StatePublished - Sep 1 2019

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Patient Discharge
Epidemiologic Effect Modifiers
Skilled Nursing Facilities
Delivery of Health Care
Decision Trees
Resource Allocation
Health Resources
Gait
Reoperation
Counseling
Inpatients
Patient Care
Logistic Models
Learning
Costs and Cost Analysis

Keywords

  • CD
  • Cervical deformity
  • Discharge
  • Outcomes
  • Rehabilitation
  • Skilled nursing facility
  • Surgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Bortz, C. A., Passias, P. G., Segreto, F., Horn, S. R., Lafage, V., Smith, J. S., ... Ames, C. P. (2019). Indicators for nonroutine discharge following cervical deformity-corrective surgery: Radiographic, surgical, and patient-related factors. Clinical Neurosurgery, 85(3), E509-E519. [nyz016]. https://doi.org/10.1093/neuros/nyz016

Indicators for nonroutine discharge following cervical deformity-corrective surgery : Radiographic, surgical, and patient-related factors. / Bortz, Cole A.; Passias, Peter G.; Segreto, Frank; Horn, Samantha R.; Lafage, Virginie; Smith, Justin S.; Line, Breton; Mundis, Gregory M.; Kebaish, Khaled M; Kelly, Michael P.; Protopsaltis, Themistocles; Sciubba, Daniel; Soroceanu, Alexandra; Klineberg, Eric O.; Burton, Douglas C.; Hart, Robert A.; Schwab, Frank J.; Bess, Shay; Shaffrey, Christopher I.; Ames, Christopher P.

In: Clinical Neurosurgery, Vol. 85, No. 3, nyz016, 01.09.2019, p. E509-E519.

Research output: Contribution to journalArticle

Bortz, CA, Passias, PG, Segreto, F, Horn, SR, Lafage, V, Smith, JS, Line, B, Mundis, GM, Kebaish, KM, Kelly, MP, Protopsaltis, T, Sciubba, D, Soroceanu, A, Klineberg, EO, Burton, DC, Hart, RA, Schwab, FJ, Bess, S, Shaffrey, CI & Ames, CP 2019, 'Indicators for nonroutine discharge following cervical deformity-corrective surgery: Radiographic, surgical, and patient-related factors', Clinical Neurosurgery, vol. 85, no. 3, nyz016, pp. E509-E519. https://doi.org/10.1093/neuros/nyz016
Bortz, Cole A. ; Passias, Peter G. ; Segreto, Frank ; Horn, Samantha R. ; Lafage, Virginie ; Smith, Justin S. ; Line, Breton ; Mundis, Gregory M. ; Kebaish, Khaled M ; Kelly, Michael P. ; Protopsaltis, Themistocles ; Sciubba, Daniel ; Soroceanu, Alexandra ; Klineberg, Eric O. ; Burton, Douglas C. ; Hart, Robert A. ; Schwab, Frank J. ; Bess, Shay ; Shaffrey, Christopher I. ; Ames, Christopher P. / Indicators for nonroutine discharge following cervical deformity-corrective surgery : Radiographic, surgical, and patient-related factors. In: Clinical Neurosurgery. 2019 ; Vol. 85, No. 3. pp. E509-E519.
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T1 - Indicators for nonroutine discharge following cervical deformity-corrective surgery

T2 - Radiographic, surgical, and patient-related factors

AU - Bortz, Cole A.

AU - Passias, Peter G.

AU - Segreto, Frank

AU - Horn, Samantha R.

AU - Lafage, Virginie

AU - Smith, Justin S.

AU - Line, Breton

AU - Mundis, Gregory M.

AU - Kebaish, Khaled M

AU - Kelly, Michael P.

AU - Protopsaltis, Themistocles

AU - Sciubba, Daniel

AU - Soroceanu, Alexandra

AU - Klineberg, Eric O.

AU - Burton, Douglas C.

AU - Hart, Robert A.

AU - Schwab, Frank J.

AU - Bess, Shay

AU - Shaffrey, Christopher I.

AU - Ames, Christopher P.

PY - 2019/9/1

Y1 - 2019/9/1

N2 - BACKGROUND: Nonroutine discharge, including discharge to inpatient rehab and skilled nursing facilities, is associated with increased cost-of-care. Given the rising prevalence of cervical deformity (CD)-corrective surgery and the necessity of value-based healthcare, it is important to identify indicators for nonroutine discharge. OBJECTIVE: To identify factors associated with nonroutine discharge after CD-corrective surgery using a statistical learning algorithm. METHODS: A retrospective review of patients ≥18 yr with discharge and baseline (BL) radiographic data. Conditional inference decision trees identified factors associated with nonroutine discharge and cut-off points at which factors were significantly associated with discharge status. A conditional variable importance table used nonreplacement sampling set of 10 000 conditional inference trees to identify influential patient/surgical factors. The binary logistic regression indicated odds of nonroutine discharge for patients with influential factors at significant cut-off points. RESULTS: Of 138 patients (61 yr, 63% female) undergoing surgery for CD (8 ± 5 levels; 49% posterior approach, 16% anterior, and 35% combined), 29% experienced nonroutine discharge. BL cervical/upper-cervical malalignment showed the strongest relationship with nonroutine discharge: C1 slope ≥ 14°, C2 slope ≥ 57°, TS-CL ≥ 57°. Patient-related factors associated with nonroutine discharge included BL gait impairment, age ≥ 59 yr and apex of CD primary driver ≥ C7. The only surgical factor associated with nonroutine discharge was fusion ≥ 8 levels. There was no relationship between nonhome discharge and reoperation within 6 mo or 1 yr (both P >. 05) of index procedure. Despite no differences in BL EQ-5D (P =. 946), nonroutine discharge patients had inferior 1-yr postoperative EQ-5D scores (P =. 044). CONCLUSION: Severe preoperative cervical malalignment was strongly associated with nonroutine discharge following CD-corrective surgery. Age, deformity driver, and ≥ 8 level fusions were also associated with nonroutine discharge and should be taken into account to improve patient counseling and health care resource allocation.

AB - BACKGROUND: Nonroutine discharge, including discharge to inpatient rehab and skilled nursing facilities, is associated with increased cost-of-care. Given the rising prevalence of cervical deformity (CD)-corrective surgery and the necessity of value-based healthcare, it is important to identify indicators for nonroutine discharge. OBJECTIVE: To identify factors associated with nonroutine discharge after CD-corrective surgery using a statistical learning algorithm. METHODS: A retrospective review of patients ≥18 yr with discharge and baseline (BL) radiographic data. Conditional inference decision trees identified factors associated with nonroutine discharge and cut-off points at which factors were significantly associated with discharge status. A conditional variable importance table used nonreplacement sampling set of 10 000 conditional inference trees to identify influential patient/surgical factors. The binary logistic regression indicated odds of nonroutine discharge for patients with influential factors at significant cut-off points. RESULTS: Of 138 patients (61 yr, 63% female) undergoing surgery for CD (8 ± 5 levels; 49% posterior approach, 16% anterior, and 35% combined), 29% experienced nonroutine discharge. BL cervical/upper-cervical malalignment showed the strongest relationship with nonroutine discharge: C1 slope ≥ 14°, C2 slope ≥ 57°, TS-CL ≥ 57°. Patient-related factors associated with nonroutine discharge included BL gait impairment, age ≥ 59 yr and apex of CD primary driver ≥ C7. The only surgical factor associated with nonroutine discharge was fusion ≥ 8 levels. There was no relationship between nonhome discharge and reoperation within 6 mo or 1 yr (both P >. 05) of index procedure. Despite no differences in BL EQ-5D (P =. 946), nonroutine discharge patients had inferior 1-yr postoperative EQ-5D scores (P =. 044). CONCLUSION: Severe preoperative cervical malalignment was strongly associated with nonroutine discharge following CD-corrective surgery. Age, deformity driver, and ≥ 8 level fusions were also associated with nonroutine discharge and should be taken into account to improve patient counseling and health care resource allocation.

KW - CD

KW - Cervical deformity

KW - Discharge

KW - Outcomes

KW - Rehabilitation

KW - Skilled nursing facility

KW - Surgery

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