Predictors of nonroutine discharge among patients undergoing surgery for grade I spondylolisthesis: insights from the Quality Outcomes Database.

Mummaneni, Praveen V

Bydon, Mohamad

Knightly, John

Alvi, Mohammed Ali

Goyal, Anshit

Chan, Andrew K

Guan, Jian

Biase, Michael

Strauss, Andrea

Glassman, Steven

Foley, Kevin T

Slotkin, Jonathan R

Potts, Eric

Shaffrey, Mark

Shaffrey, Christopher I

Haid, Regis W

Fu, Kai-Ming

Wang, Michael Y

Park, Paul

Asher, Anthony L

Bisson, Erica F

2019-12-15T16:53:55Z

2019-12-15T16:53:55Z

2019-12-06

2019-12-15T16:53:55Z

OBJECTIVE:Discharge to an inpatient rehabilitation facility or another acute-care facility not only constitutes a postoperative challenge for patients and their care team but also contributes significantly to healthcare costs. In this era of changing dynamics of healthcare payment models in which cost overruns are being increasingly shifted to surgeons and hospitals, it is important to better understand outcomes such as discharge disposition. In the current article, the authors sought to develop a predictive model for factors associated with nonroutine discharge after surgery for grade I spondylolisthesis. METHODS:The authors queried the Quality Outcomes Database for patients with grade I lumbar degenerative spondylolisthesis who underwent a surgical intervention between July 2014 and June 2016. Only those patients enrolled in a multisite study investigating the impact of fusion on clinical and patient-reported outcomes among patients with grade I spondylolisthesis were evaluated. Nonroutine discharge was defined as those who were discharged to a postacute or nonacute-care setting in the same hospital or transferred to another acute-care facility. RESULTS:Of the 608 patients eligible for inclusion, 9.4% (n = 57) had a nonroutine discharge (8.7%, n = 53 discharged to inpatient postacute or nonacute care in the same hospital and 0.7%, n = 4 transferred to another acute-care facility). Compared to patients who were discharged to home, patients who had a nonroutine discharge were more likely to have diabetes (26.3%, n = 15 vs 15.7%, n = 86, p = 0.039); impaired ambulation (26.3%, n = 15 vs 10.2%, n = 56, p < 0.001); higher Oswestry Disability Index at baseline (51 [IQR 42-62.12] vs 46 [IQR 34.4-58], p = 0.014); lower EuroQol-5D scores (0.437 [IQR 0.308-0.708] vs 0.597 [IQR 0.358-0.708], p = 0.010); higher American Society of Anesthesiologists score (3 or 4: 63.2%, n = 36 vs 36.7%, n = 201, p = 0.002); and longer length of stay (4 days [IQR 3-5] vs 2 days [IQR 1-3], p < 0.001); and were more likely to suffer a complication (14%, n = 8 vs 5.6%, n = 31, p = 0.014). On multivariable logistic regression, factors found to be independently associated with higher odds of nonroutine discharge included older age (interquartile OR 9.14, 95% CI 3.79-22.1, p < 0.001), higher body mass index (interquartile OR 2.04, 95% CI 1.31-3.25, p < 0.001), presence of depression (OR 4.28, 95% CI 1.96-9.35, p < 0.001), fusion surgery compared with decompression alone (OR 1.3, 95% CI 1.1-1.6, p < 0.001), and any complication (OR 3.9, 95% CI 1.4-10.9, p < 0.001). CONCLUSIONS:In this multisite study of a defined cohort of patients undergoing surgery for grade I spondylolisthesis, factors associated with higher odds of nonroutine discharge included older age, higher body mass index, presence of depression, and occurrence of any complication.

2019.9.SPINE19644

1547-5654

1547-5646

https://hdl.handle.net/10161/19579

eng

Journal of Neurosurgery Publishing Group (JNSPG)

Journal of neurosurgery. Spine

10.3171/2019.9.spine19644

ASA = American Society of Anesthesiologists

AUC = area under the curve

BMI = body mass index

EQ-5D = EuroQol-5D

IQR = interquartile range

NRS = numeric rating scale

ODI = Oswestry Disability Index

PRO = patient-reported outcome

QOD

QOD = Quality Outcomes Database

Quality Outcomes Database

SNF = skilled nursing facility

discharge disposition

lumbar spine

nonroutine discharge

spine surgery

spondylolisthesis

Predictors of nonroutine discharge among patients undergoing surgery for grade I spondylolisthesis: insights from the Quality Outcomes Database.

Journal article

Shaffrey, Christopher I|0000-0001-9760-8386

1

10

School of Medicine

Duke

Orthopaedics

Clinical Science Departments

Neurosurgery

Published