Discharge Destination as a Predictor of Postoperative Outcomes and Readmission Following Posterior Lumbar Fusion

Posterior lumbar fusions are performed to treat various spinal deformities, degenerative diseases, fractures, infections, and tumors. The possibility of episode-based bundled payments for spine surgery necessitates analysis of the factors predicting readmissions and postoperative complications. Pati...

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Bibliographic Details
Published in:World neurosurgery 2019-02, Vol.122, p.e139-e146
Main Authors: Arrighi-Allisan, Annie E., Neifert, Sean N., Gal, Jonathan S., Deutsch, Brian C., Caridi, John M.
Format: Article
Language:English
Subjects:
Bundled payments
Nonhome discharge
Outcomes
Posterior lumbar fusion
Post–acute care facilities
Readmissions
Spine surgery
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Summary:Posterior lumbar fusions are performed to treat various spinal deformities, degenerative diseases, fractures, infections, and tumors. The possibility of episode-based bundled payments for spine surgery necessitates analysis of the factors predicting readmissions and postoperative complications. Patients undergoing posterior lumbar fusion in the American College of Surgeons National Surgical Quality Improvement Program were queried via Current Procedural Terminology codes 22630, 22633, and 22612. Patients were grouped based on discharge destination, either to home/home health care or to a facility. Relevant demographics, comorbidities, perioperative statistics, and predischarge and postdischarge complications were compared. Multivariable logistic regression models for severe postdischarge complications and 30-day readmissions were created with the exposure of nonhome discharge. Patients discharged to nonhome destinations were significantly older (68.42 vs. 58.15 years; P < 0.0001), sicker (68.11% of patients had American Society of Anesthesiologists Physical Status Classification > 2 vs. 44.25%; P < 0.0001), more dependent (5.92% vs. 1.40%; P  40 vs. 7.63%; P 
ISSN:1878-8750
1878-8769
DOI:10.1016/j.wneu.2018.09.147