Impact of discharge to subacute rehabilitation or home with health services on prolonged length of stay and increased inpatient expense following elective surgery for cervical spondylotic myelopathy: a propensity score-matched Quality Outcomes Database study.

Abstract

ObjectiveSurgery for cervical spondylotic myelopathy (CSM) is becoming increasingly common and costly. Using propensity score matching to rigorously control for demographic, clinical, and surgical confounders, the authors provide the most refined assessment yet of the impact of discharge to subacute rehabilitation (SAR) or home with health services on excess length of stay (LOS) and inpatient expense following surgery for CSM.MethodsThe prospective Quality Outcomes Database was used to assess patients undergoing surgery for CSM. Propensity score matching was used to balance 12 covariates between patients discharged home and those discharged to SAR, as well as between patients discharged home and those discharged home with health services. The mean LOS, complications, and patient-reported outcomes (at baseline and 3, 12, and 24 months postoperatively) were compared between discharge destinations. Excess LOS was multiplied by the adjusted expense per inpatient day to calculate excess expense.ResultsAfter matching, there were no significant baseline differences between discharge cohorts. Discharge to SAR was associated with a mean excess LOS of 2.7 days and an additional inpatient expense of $8168, while discharge home with health services resulted in a mean excess LOS of 0.9 days and an additional inpatient expense of $2723. Patients discharged to SAR had lower patient satisfaction at 3 months, worse EQ-5D scores at 12 and 24 months, and worse modified Japanese Orthopaedic Association scores at 3 months. Those discharged home with health services had lower patient satisfaction and EQ-5D scores at 12 months postoperatively.ConclusionsThese findings underscore the need for proactive, targeted discharge planning to minimize prolonged LOS and reduce healthcare costs, particularly in the context of increasingly common elective CSM surgery and the emergence of alternative payment models. By optimizing discharge processes, payors and hospital administrators can improve resource utilization, enhance patient satisfaction, and reduce financial burdens on healthcare systems.