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 - 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
UR - http://www.scopus.com/inward/record.url?scp=85042104629&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85042104629&partnerID=8YFLogxK
U2 - 10.1093/neuros/nyx057
DO - 10.1093/neuros/nyx057
M3 - Article
C2 - 28486638
AN - SCOPUS:85042104629
SN - 0069-4827
VL - 81
SP - 638
EP - 649
JO - Clinical neurosurgery
JF - Clinical neurosurgery
IS - 4
ER -