Predictors of discharge to a nonhome facility in patients undergoing lumbar decompression without fusion for degenerative spine disease

Meghan E. Murphy, Patrick R. Maloney, Brandon A. McCutcheon, Lorenzo Rinaldo, Daniel Shepherd, Panagiotis Kerezoudis, Hannah Gilder, Daniel S. Ubl, Cynthia Crowson, Brett Freedman, Elizabeth B Habermann, Bydon Mohamad Bydon

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

BACKGROUND: Patients recovering from decompressive laminectomy without fusion May require assistance with activities of daily living and physical/occupational therapy upon hospital discharge. OBJECTIVE: To examine comorbidities and perioperative characteristics of patients undergoing lumbar decompression for associations with discharge status using a multicenter database. METHODS: A multicenter database was used for this retrospective cohort analysis. Patients admitted from home with degenerative spine disease for lumbar decompression without fusion were included. Thirty-day outcomes and operative characteristics were compared as a function of patient discharge using chi-square and Wilcoxon Rank Sum tests. Multivariable logistic regression was used to determine factors associated with discharge to a nonhome facility. RESULTS: Of the 8627 patients included for analysis, 9.7% were discharged to a nonhome facility. On multivariable analysis, age (85+ vs <65, odds ratio [OR] 13.59), number of levels of decompression (3+ vs 1, OR 1.75), African American race vs Non-Hispanic or Hispanic White (OR 1.87), female vs male gender (OR 1.97), body mass index (BMI) (40+ vs 18.5-24.9, OR 1.74), American Society of Anesthesiologists physical classification status (4 vs 1 or 2, OR 2.35), hypertension (OR 1.29), dependent functional status (OR 3.92), diabetes (OR 1.47), smoking (OR 1.40), hematocrit (<35 vs 35+, OR 1.76), international normalized ratio (=1.3 vs <1.3, OR 2.32), and operative time (3+ h vs <1 h, OR 5.34) were significantly associated with an increased odds of discharge to nonhome facilities. CONCLUSION: Preoperative status and operative course variables can influence discharge disposition in lumbar decompression patients. Identifying specific factors that contribute to a greater likelihood of dismissal to skilled facility or rehabilitation unit can further inform both surgeons and patients during preoperative counseling and disposition planning.

Original languageEnglish (US)
Pages (from-to)638-649
Number of pages12
JournalClinical Neurosurgery
Volume81
Issue number4
DOIs
StatePublished - Oct 1 2017

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Decompression
Spine
Odds Ratio
Nonparametric Statistics
Databases
Laminectomy
International Normalized Ratio
Patient Discharge
Occupational Therapy
Operative Time
Activities of Daily Living
Hematocrit
Hispanic Americans
African Americans
Comorbidity
Counseling
Body Mass Index
Cohort Studies
Rehabilitation
Logistic Models

Keywords

  • Lumbar decompression
  • Patient discharge
  • Risk factors

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Murphy, M. E., Maloney, P. R., McCutcheon, B. A., Rinaldo, L., Shepherd, D., Kerezoudis, P., ... Mohamad Bydon, B. (2017). Predictors of discharge to a nonhome facility in patients undergoing lumbar decompression without fusion for degenerative spine disease. Clinical Neurosurgery, 81(4), 638-649. https://doi.org/10.1093/neuros/nyx057

Predictors of discharge to a nonhome facility in patients undergoing lumbar decompression without fusion for degenerative spine disease. / Murphy, Meghan E.; Maloney, Patrick R.; McCutcheon, Brandon A.; Rinaldo, Lorenzo; Shepherd, Daniel; Kerezoudis, Panagiotis; Gilder, Hannah; Ubl, Daniel S.; Crowson, Cynthia; Freedman, Brett; Habermann, Elizabeth B; Mohamad Bydon, Bydon.

In: Clinical Neurosurgery, Vol. 81, No. 4, 01.10.2017, p. 638-649.

Research output: Contribution to journalArticle

Murphy, ME, Maloney, PR, McCutcheon, BA, Rinaldo, L, Shepherd, D, Kerezoudis, P, Gilder, H, Ubl, DS, Crowson, C, Freedman, B, Habermann, EB & Mohamad Bydon, B 2017, 'Predictors of discharge to a nonhome facility in patients undergoing lumbar decompression without fusion for degenerative spine disease', Clinical Neurosurgery, vol. 81, no. 4, pp. 638-649. https://doi.org/10.1093/neuros/nyx057
Murphy, Meghan E. ; Maloney, Patrick R. ; McCutcheon, Brandon A. ; Rinaldo, Lorenzo ; Shepherd, Daniel ; Kerezoudis, Panagiotis ; Gilder, Hannah ; Ubl, Daniel S. ; Crowson, Cynthia ; Freedman, Brett ; Habermann, Elizabeth B ; Mohamad Bydon, Bydon. / Predictors of discharge to a nonhome facility in patients undergoing lumbar decompression without fusion for degenerative spine disease. In: Clinical Neurosurgery. 2017 ; Vol. 81, No. 4. pp. 638-649.
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AU - Rinaldo, Lorenzo

AU - Shepherd, Daniel

AU - Kerezoudis, Panagiotis

AU - Gilder, Hannah

AU - Ubl, Daniel S.

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N2 - BACKGROUND: Patients recovering from decompressive laminectomy without fusion May require assistance with activities of daily living and physical/occupational therapy upon hospital discharge. OBJECTIVE: To examine comorbidities and perioperative characteristics of patients undergoing lumbar decompression for associations with discharge status using a multicenter database. METHODS: A multicenter database was used for this retrospective cohort analysis. Patients admitted from home with degenerative spine disease for lumbar decompression without fusion were included. Thirty-day outcomes and operative characteristics were compared as a function of patient discharge using chi-square and Wilcoxon Rank Sum tests. Multivariable logistic regression was used to determine factors associated with discharge to a nonhome facility. RESULTS: Of the 8627 patients included for analysis, 9.7% were discharged to a nonhome facility. On multivariable analysis, age (85+ vs <65, odds ratio [OR] 13.59), number of levels of decompression (3+ vs 1, OR 1.75), African American race vs Non-Hispanic or Hispanic White (OR 1.87), female vs male gender (OR 1.97), body mass index (BMI) (40+ vs 18.5-24.9, OR 1.74), American Society of Anesthesiologists physical classification status (4 vs 1 or 2, OR 2.35), hypertension (OR 1.29), dependent functional status (OR 3.92), diabetes (OR 1.47), smoking (OR 1.40), hematocrit (<35 vs 35+, OR 1.76), international normalized ratio (=1.3 vs <1.3, OR 2.32), and operative time (3+ h vs <1 h, OR 5.34) were significantly associated with an increased odds of discharge to nonhome facilities. CONCLUSION: Preoperative status and operative course variables can influence discharge disposition in lumbar decompression patients. Identifying specific factors that contribute to a greater likelihood of dismissal to skilled facility or rehabilitation unit can further inform both surgeons and patients during preoperative counseling and disposition planning.

AB - BACKGROUND: Patients recovering from decompressive laminectomy without fusion May require assistance with activities of daily living and physical/occupational therapy upon hospital discharge. OBJECTIVE: To examine comorbidities and perioperative characteristics of patients undergoing lumbar decompression for associations with discharge status using a multicenter database. METHODS: A multicenter database was used for this retrospective cohort analysis. Patients admitted from home with degenerative spine disease for lumbar decompression without fusion were included. Thirty-day outcomes and operative characteristics were compared as a function of patient discharge using chi-square and Wilcoxon Rank Sum tests. Multivariable logistic regression was used to determine factors associated with discharge to a nonhome facility. RESULTS: Of the 8627 patients included for analysis, 9.7% were discharged to a nonhome facility. On multivariable analysis, age (85+ vs <65, odds ratio [OR] 13.59), number of levels of decompression (3+ vs 1, OR 1.75), African American race vs Non-Hispanic or Hispanic White (OR 1.87), female vs male gender (OR 1.97), body mass index (BMI) (40+ vs 18.5-24.9, OR 1.74), American Society of Anesthesiologists physical classification status (4 vs 1 or 2, OR 2.35), hypertension (OR 1.29), dependent functional status (OR 3.92), diabetes (OR 1.47), smoking (OR 1.40), hematocrit (<35 vs 35+, OR 1.76), international normalized ratio (=1.3 vs <1.3, OR 2.32), and operative time (3+ h vs <1 h, OR 5.34) were significantly associated with an increased odds of discharge to nonhome facilities. CONCLUSION: Preoperative status and operative course variables can influence discharge disposition in lumbar decompression patients. Identifying specific factors that contribute to a greater likelihood of dismissal to skilled facility or rehabilitation unit can further inform both surgeons and patients during preoperative counseling and disposition planning.

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