TY - JOUR
T1 - Patient- and hospital-related risk factors for non-routine discharge after lumbar decompression and fusion for spondylolisthesis
AU - Elsamadicy, Aladine A.
AU - Freedman, Isaac G.
AU - Koo, Andrew B.
AU - David, Wyatt
AU - Hengartner, Astrid C.
AU - Havlik, John
AU - Reeves, Benjamin C.
AU - Hersh, Andrew
AU - Pennington, Zach
AU - Kolb, Luis
AU - Laurans, Maxwell
AU - Shin, John H.
AU - Sciubba, Daniel M.
N1 - Publisher Copyright:
© 2021
PY - 2021/10
Y1 - 2021/10
N2 - Objective: In various spinal surgeries, non-routine discharges have been associated with inferior outcomes. However, there exists a paucity of data regarding the relationship between non-routine discharge and quality of care among patients with spondylolisthesis. The aim of this study was to identify independent predictors for non-routine discharge following spinal decompression and fusion for lumbar spondylolisthesis. Methods: A retrospective cohort study was performed using the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database from 2010 through 2016. Adult patients (≥18 years old) who underwent spinal decompression and fusion for lumbar spondylolisthesis were identified using ICD-9-CM diagnosis and CPT procedural coding systems. The study population was divided into two cohorts based on discharge disposition: routine (RD) and non-routine discharge (NRD). Patient demographics, comorbidities, adverse events, LOS, reoperation, and readmission were assessed. A multivariate logistic regression model was used to identify the independent predictors of non-home discharge and 30-day unplanned readmission. Results: A total of 5252 patients were identified, of which 4316 (82.2%) had a RD and 936 (18.8%) had a NRD. The NRD cohort tended to be older (p < 0.001) and have a higher BMI (p < 0.001). Patients who experienced a NRD had a longer LOS (NRD: 4.7 ± 3.7 days vs RD: 3.1 ± 2.0 days, p < 0.001), a higher proportion of adverse events (p < 0.001), higher rates of reoperation (p = 0.005) and unplanned 30-day readmission rates (p < 0.001). On multivariate regression analysis, age [OR: 1.08, 95% CI (1.06–1.10), p < 0.001], female sex [OR: 2.01, 95% (1.51–2.69), p < 0.001], non-Hispanic Black race/ethnicity [OR: 2.10, 95% CI (1.36–3.24), p = 0.001], BMI [OR: 1.03, 95% CI (1.01–1.05), p = 0.007], dependent functional status [OR: 3.33, 95% CI (1.59 – 6.99), p = 0.001], malnourishment [OR: 2.14, 95% CI (1.27–3.62), p = 0.005], and LOS [OR: 1.26, 95% CI (1.18–1.33), p < 0.001] were all independent predictors for NRD. However, NRD did not independently predict an unplanned 30-day readmission on multivariate analysis. Conclusion: In our study we found that on univariate analysis NRD was associated with increased adverse events, length of stay and 30-day unplanned readmission. When controlling for patient- and hospital-related factors, we found that female sex, non-Hispanic Black race, BMI, dependent functional status, malnourishment and longer LOS were independently associated with NRD. However, NRD did not independently predict an unplanned 30-day readmission.
AB - Objective: In various spinal surgeries, non-routine discharges have been associated with inferior outcomes. However, there exists a paucity of data regarding the relationship between non-routine discharge and quality of care among patients with spondylolisthesis. The aim of this study was to identify independent predictors for non-routine discharge following spinal decompression and fusion for lumbar spondylolisthesis. Methods: A retrospective cohort study was performed using the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database from 2010 through 2016. Adult patients (≥18 years old) who underwent spinal decompression and fusion for lumbar spondylolisthesis were identified using ICD-9-CM diagnosis and CPT procedural coding systems. The study population was divided into two cohorts based on discharge disposition: routine (RD) and non-routine discharge (NRD). Patient demographics, comorbidities, adverse events, LOS, reoperation, and readmission were assessed. A multivariate logistic regression model was used to identify the independent predictors of non-home discharge and 30-day unplanned readmission. Results: A total of 5252 patients were identified, of which 4316 (82.2%) had a RD and 936 (18.8%) had a NRD. The NRD cohort tended to be older (p < 0.001) and have a higher BMI (p < 0.001). Patients who experienced a NRD had a longer LOS (NRD: 4.7 ± 3.7 days vs RD: 3.1 ± 2.0 days, p < 0.001), a higher proportion of adverse events (p < 0.001), higher rates of reoperation (p = 0.005) and unplanned 30-day readmission rates (p < 0.001). On multivariate regression analysis, age [OR: 1.08, 95% CI (1.06–1.10), p < 0.001], female sex [OR: 2.01, 95% (1.51–2.69), p < 0.001], non-Hispanic Black race/ethnicity [OR: 2.10, 95% CI (1.36–3.24), p = 0.001], BMI [OR: 1.03, 95% CI (1.01–1.05), p = 0.007], dependent functional status [OR: 3.33, 95% CI (1.59 – 6.99), p = 0.001], malnourishment [OR: 2.14, 95% CI (1.27–3.62), p = 0.005], and LOS [OR: 1.26, 95% CI (1.18–1.33), p < 0.001] were all independent predictors for NRD. However, NRD did not independently predict an unplanned 30-day readmission on multivariate analysis. Conclusion: In our study we found that on univariate analysis NRD was associated with increased adverse events, length of stay and 30-day unplanned readmission. When controlling for patient- and hospital-related factors, we found that female sex, non-Hispanic Black race, BMI, dependent functional status, malnourishment and longer LOS were independently associated with NRD. However, NRD did not independently predict an unplanned 30-day readmission.
KW - healthcare utilization
KW - length of stay
KW - lumbar fusion
KW - non-routine discharge
KW - spondylolisthesis
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U2 - 10.1016/j.clineuro.2021.106902
DO - 10.1016/j.clineuro.2021.106902
M3 - Article
C2 - 34481141
AN - SCOPUS:85113965292
SN - 0303-8467
VL - 209
JO - Clinical Neurology and Neurosurgery
JF - Clinical Neurology and Neurosurgery
M1 - 106902
ER -