TY - JOUR
T1 - Predictors of discharge to a nonhome facility in patients undergoing lumbar decompression without fusion for degenerative spine disease
AU - Murphy, Meghan E.
AU - Maloney, Patrick R.
AU - McCutcheon, Brandon A.
AU - Rinaldo, Lorenzo
AU - Shepherd, Daniel
AU - Kerezoudis, Panagiotis
AU - Gilder, Hannah
AU - Ubl, Daniel S.
AU - Crowson, Cynthia S.
AU - Freedman, Brett A.
AU - Habermann, Elizabeth B.
AU - Mohamad Bydon, Bydon
N1 - Funding Information:
This publication was made possible by funding from the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.
Publisher Copyright:
Copyright © 2017 by the Congress of Neurological Surgeons.
PY - 2017/10/1
Y1 - 2017/10/1
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.
KW - Lumbar decompression
KW - Patient discharge
KW - Risk factors
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U2 - 10.1093/neuros/nyx057
DO - 10.1093/neuros/nyx057
M3 - Article
C2 - 28486638
AN - SCOPUS:85042104629
SN - 0148-396X
VL - 81
SP - 638
EP - 649
JO - Neurosurgery
JF - Neurosurgery
IS - 4
ER -