Risk factors for nonroutine discharge in adult spinal deformity surgery

Raj M. Amin, Micheal Raad, Amit Jain, Morsi Khashan, Hamid Hassanzadeh, Steven Mark Frank, Khaled M Kebaish

Research output: Contribution to journalArticle

Abstract

BACKGROUND CONTEXT: Surgery for adult spinal deformity (ASD) is increasingly common. Although outcomes of ASD surgery have been studied extensively, to our knowledge, no data exist regarding factors predicting nonroutine discharge in this population. Nonroutine discharge is defined as discharge to a health care facility after surgery rather than to home. PURPOSE: To determine which patient and surgical factors predict nonroutine discharge after ASD surgery. DESIGN: This is a retrospective study. PATIENTS SAMPLE: We conducted a retrospective single-center study of 303 patients who underwent arthrodesis of five or more spinal levels to treat ASD between 2009 and 2014. OUTCOME MEASURES: Patients were stratified into two groups according to discharge disposition: home or nonroutine. METHODS: Objective preoperative characteristics, intraoperative course, and postoperative recovery were analyzed to identify pre- and perioperative factors associated with nonroutine discharge. Univariate analysis was performed first. All factors with P values <.2 on univariate analysis were included in a logistic regression model. Additionally, to understand the relationship between subjective patient-reported outcome measures and nonroutine discharge, we compared the two groups with respect to mean Oswestry Disability Index and Scoliosis Research Society-22r domains using Student t-tests. RESULTS: On univariate analysis, objective measures that differed significantly (P <.05) between the two cohorts were age (≥65 years), osteoporosis, Charlson Comorbidity Index score of ≥2, prolonged hospital stay (>8 days), and blood transfusion. Given the above logistic regression inclusion criteria, we controlled for the performance, and type, of osteotomy (P =.055). On multivariate analysis, older age, osteoporosis, prolonged hospital stay, blood transfusion, and 3-column osteotomy were independently associated with nonroutine discharge. Subjective patient-reported outcome measures, including Oswestry Disability Index and Scoliosis Research Society-22r physical function and pain domain scores, were significantly worse in the nonroutine discharge cohort (P <.05). CONCLUSION: To our knowledge, this is the first study to evaluate pre- and perioperative factors associated with nonroutine discharge after ASD surgery. Elderly patients who undergo complex surgery and receive blood transfusions are at particularly high risk of nonroutine discharge. Surgeons should consider these factors during surgical planning and preoperative patient counseling.

Original languageEnglish (US)
JournalSpine Journal
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Blood Transfusion
Osteotomy
Arthrodesis
Health Facilities
Scoliosis
Osteoporosis
Counseling
Length of Stay
Multivariate Analysis
Retrospective Studies
Logistic Models
Delivery of Health Care
Pain
Research
Population
Surgeons
Patient Reported Outcome Measures

Keywords

  • 3-column osteotomy
  • Adult spinal deformity
  • Blood transfusion
  • Charlson Comorbidity Index
  • Osteoporosis
  • Spinal arthrodesis

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Risk factors for nonroutine discharge in adult spinal deformity surgery. / Amin, Raj M.; Raad, Micheal; Jain, Amit; Khashan, Morsi; Hassanzadeh, Hamid; Frank, Steven Mark; Kebaish, Khaled M.

In: Spine Journal, 01.01.2018.

Research output: Contribution to journalArticle

@article{b68f7298da754e78a284b29134307d23,
title = "Risk factors for nonroutine discharge in adult spinal deformity surgery",
abstract = "BACKGROUND CONTEXT: Surgery for adult spinal deformity (ASD) is increasingly common. Although outcomes of ASD surgery have been studied extensively, to our knowledge, no data exist regarding factors predicting nonroutine discharge in this population. Nonroutine discharge is defined as discharge to a health care facility after surgery rather than to home. PURPOSE: To determine which patient and surgical factors predict nonroutine discharge after ASD surgery. DESIGN: This is a retrospective study. PATIENTS SAMPLE: We conducted a retrospective single-center study of 303 patients who underwent arthrodesis of five or more spinal levels to treat ASD between 2009 and 2014. OUTCOME MEASURES: Patients were stratified into two groups according to discharge disposition: home or nonroutine. METHODS: Objective preoperative characteristics, intraoperative course, and postoperative recovery were analyzed to identify pre- and perioperative factors associated with nonroutine discharge. Univariate analysis was performed first. All factors with P values <.2 on univariate analysis were included in a logistic regression model. Additionally, to understand the relationship between subjective patient-reported outcome measures and nonroutine discharge, we compared the two groups with respect to mean Oswestry Disability Index and Scoliosis Research Society-22r domains using Student t-tests. RESULTS: On univariate analysis, objective measures that differed significantly (P <.05) between the two cohorts were age (≥65 years), osteoporosis, Charlson Comorbidity Index score of ≥2, prolonged hospital stay (>8 days), and blood transfusion. Given the above logistic regression inclusion criteria, we controlled for the performance, and type, of osteotomy (P =.055). On multivariate analysis, older age, osteoporosis, prolonged hospital stay, blood transfusion, and 3-column osteotomy were independently associated with nonroutine discharge. Subjective patient-reported outcome measures, including Oswestry Disability Index and Scoliosis Research Society-22r physical function and pain domain scores, were significantly worse in the nonroutine discharge cohort (P <.05). CONCLUSION: To our knowledge, this is the first study to evaluate pre- and perioperative factors associated with nonroutine discharge after ASD surgery. Elderly patients who undergo complex surgery and receive blood transfusions are at particularly high risk of nonroutine discharge. Surgeons should consider these factors during surgical planning and preoperative patient counseling.",
keywords = "3-column osteotomy, Adult spinal deformity, Blood transfusion, Charlson Comorbidity Index, Osteoporosis, Spinal arthrodesis",
author = "Amin, {Raj M.} and Micheal Raad and Amit Jain and Morsi Khashan and Hamid Hassanzadeh and Frank, {Steven Mark} and Kebaish, {Khaled M}",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.spinee.2018.06.366",
language = "English (US)",
journal = "Spine Journal",
issn = "1529-9430",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Risk factors for nonroutine discharge in adult spinal deformity surgery

AU - Amin, Raj M.

AU - Raad, Micheal

AU - Jain, Amit

AU - Khashan, Morsi

AU - Hassanzadeh, Hamid

AU - Frank, Steven Mark

AU - Kebaish, Khaled M

PY - 2018/1/1

Y1 - 2018/1/1

N2 - BACKGROUND CONTEXT: Surgery for adult spinal deformity (ASD) is increasingly common. Although outcomes of ASD surgery have been studied extensively, to our knowledge, no data exist regarding factors predicting nonroutine discharge in this population. Nonroutine discharge is defined as discharge to a health care facility after surgery rather than to home. PURPOSE: To determine which patient and surgical factors predict nonroutine discharge after ASD surgery. DESIGN: This is a retrospective study. PATIENTS SAMPLE: We conducted a retrospective single-center study of 303 patients who underwent arthrodesis of five or more spinal levels to treat ASD between 2009 and 2014. OUTCOME MEASURES: Patients were stratified into two groups according to discharge disposition: home or nonroutine. METHODS: Objective preoperative characteristics, intraoperative course, and postoperative recovery were analyzed to identify pre- and perioperative factors associated with nonroutine discharge. Univariate analysis was performed first. All factors with P values <.2 on univariate analysis were included in a logistic regression model. Additionally, to understand the relationship between subjective patient-reported outcome measures and nonroutine discharge, we compared the two groups with respect to mean Oswestry Disability Index and Scoliosis Research Society-22r domains using Student t-tests. RESULTS: On univariate analysis, objective measures that differed significantly (P <.05) between the two cohorts were age (≥65 years), osteoporosis, Charlson Comorbidity Index score of ≥2, prolonged hospital stay (>8 days), and blood transfusion. Given the above logistic regression inclusion criteria, we controlled for the performance, and type, of osteotomy (P =.055). On multivariate analysis, older age, osteoporosis, prolonged hospital stay, blood transfusion, and 3-column osteotomy were independently associated with nonroutine discharge. Subjective patient-reported outcome measures, including Oswestry Disability Index and Scoliosis Research Society-22r physical function and pain domain scores, were significantly worse in the nonroutine discharge cohort (P <.05). CONCLUSION: To our knowledge, this is the first study to evaluate pre- and perioperative factors associated with nonroutine discharge after ASD surgery. Elderly patients who undergo complex surgery and receive blood transfusions are at particularly high risk of nonroutine discharge. Surgeons should consider these factors during surgical planning and preoperative patient counseling.

AB - BACKGROUND CONTEXT: Surgery for adult spinal deformity (ASD) is increasingly common. Although outcomes of ASD surgery have been studied extensively, to our knowledge, no data exist regarding factors predicting nonroutine discharge in this population. Nonroutine discharge is defined as discharge to a health care facility after surgery rather than to home. PURPOSE: To determine which patient and surgical factors predict nonroutine discharge after ASD surgery. DESIGN: This is a retrospective study. PATIENTS SAMPLE: We conducted a retrospective single-center study of 303 patients who underwent arthrodesis of five or more spinal levels to treat ASD between 2009 and 2014. OUTCOME MEASURES: Patients were stratified into two groups according to discharge disposition: home or nonroutine. METHODS: Objective preoperative characteristics, intraoperative course, and postoperative recovery were analyzed to identify pre- and perioperative factors associated with nonroutine discharge. Univariate analysis was performed first. All factors with P values <.2 on univariate analysis were included in a logistic regression model. Additionally, to understand the relationship between subjective patient-reported outcome measures and nonroutine discharge, we compared the two groups with respect to mean Oswestry Disability Index and Scoliosis Research Society-22r domains using Student t-tests. RESULTS: On univariate analysis, objective measures that differed significantly (P <.05) between the two cohorts were age (≥65 years), osteoporosis, Charlson Comorbidity Index score of ≥2, prolonged hospital stay (>8 days), and blood transfusion. Given the above logistic regression inclusion criteria, we controlled for the performance, and type, of osteotomy (P =.055). On multivariate analysis, older age, osteoporosis, prolonged hospital stay, blood transfusion, and 3-column osteotomy were independently associated with nonroutine discharge. Subjective patient-reported outcome measures, including Oswestry Disability Index and Scoliosis Research Society-22r physical function and pain domain scores, were significantly worse in the nonroutine discharge cohort (P <.05). CONCLUSION: To our knowledge, this is the first study to evaluate pre- and perioperative factors associated with nonroutine discharge after ASD surgery. Elderly patients who undergo complex surgery and receive blood transfusions are at particularly high risk of nonroutine discharge. Surgeons should consider these factors during surgical planning and preoperative patient counseling.

KW - 3-column osteotomy

KW - Adult spinal deformity

KW - Blood transfusion

KW - Charlson Comorbidity Index

KW - Osteoporosis

KW - Spinal arthrodesis

UR - http://www.scopus.com/inward/record.url?scp=85052333458&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85052333458&partnerID=8YFLogxK

U2 - 10.1016/j.spinee.2018.06.366

DO - 10.1016/j.spinee.2018.06.366

M3 - Article

JO - Spine Journal

JF - Spine Journal

SN - 1529-9430

ER -