Posterior Cervical Decompression and Fusion: Assessing Risk Factors for Nonhome Discharge and the Impact of Disposition on Postdischarge Outcomes.

Posterior Cervical Decompression and Fusion: Assessing Risk Factors for Nonhome Discharge and the Impact of Disposition on Postdischarge Outcomes.

World Neurosurg. 2019 Feb 11;:

Authors: Snyder DJ, Neifert SN, Gal JS, Deutsch BC, Caridi JM

Abstract
BACKGROUND: The purpose of this study was to identify predictors for post-acute care facility discharge for patients undergoing posterior cervical decompression and fusion (PCDF), and to determine if discharge placement impacts post-discharge outcomes.
METHODS: Patients undergoing PCDF from 2012-2015 were queried from the NSQIP database (n=8,743) and separated by discharge placement. Outcomes included non-home discharge, unplanned 30-day readmission, and adverse events (AE), both pre- and post-discharge. Demographics and comorbidities were analyzed using bivariate analysis. Multivariate logistic regression was used to identify predictors for non-home discharge, readmission, and severe AE post-discharge.
RESULTS: Patients with non-home discharges were significantly older (67.4 vs. 58.6 years, p<.001), sicker (82% vs. 54% ASA >2, p<.001), and more functionally dependent (16% vs. 3.4%, p<.001), with a greater comorbidity burden. PCDF patients had an increased likelihood of non-home discharge if they had a dependent functional status (OR=2.99, 95% CI: 2.33 - 3.82; p<.001), diabetes (OR=1.32, 95% CI: 1.13 - 1.55; p=.0007), and an ASA >2 (OR=1.75, 95% CI: 1.5 - 2.05; p<.001), as well as if they were older (OR=1.06, 95% CI: 1.05 - 1.06; p<.001) and female (OR=1.31, 95% CI: 1.14 - 1.5; p=0.0002). PCDF patients with non-home discharges had an increased likelihood of having a severe postdischarge AE (OR=1.71, 95% CI: 1.26 - 2.33; p=0.0006) and an unplanned readmission (OR=1.45, 95% CI: 1.15 - 1.82; p=0.002).
CONCLUSION: Results of this cross-sectional study suggest PCDF patients discharged to a PAC facility have a higher likelihood of having a severe AE post-discharge as well as a higher likelihood of being readmitted.

PMID: 30763752 [PubMed - as supplied by publisher]

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