Predictors for Non-Home Patient Discharge Following Elective Adult Spinal Deformity Surgery

Study Design: Retrospective cohort study. Objectives: Adult spinal deformity (ASD) surgery encompasses a wide variety of spinal disorders and is associated with a morbidity rate between 20% and 80%. The utilization of spinal surgery has increased and this trend is expected to continue. To effectivel...

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Published in:Global spine journal 2018-05, Vol.8 (3), p.266-272
Main Authors: Di Capua, John, Somani, Sulaiman, Lugo-Fagundo, Nahyr, Kim, Jun S., Phan, Kevin, Lee, Nathan J., Kothari, Parth, Shin, John, Cho, Samuel K.
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container_title Global spine journal
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creator Di Capua, John
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description Study Design: Retrospective cohort study. Objectives: Adult spinal deformity (ASD) surgery encompasses a wide variety of spinal disorders and is associated with a morbidity rate between 20% and 80%. The utilization of spinal surgery has increased and this trend is expected to continue. To effectively deal with an increasing patient volume, identifying variables associated with patient discharge destination can expedite placement and reduce length of stay. Methods: The 2013-2014 American College of Surgeons National Surgical Quality Improvement Program database was queried using Current Procedural Terminology and International Classification of Diseases, Ninth Revision diagnosis codes relevant to ASD. Patients were divided based on discharge destination. Bivariate and multivariate logistic regression analyses were employed to identify predictors for patient discharge destination and hospital length of stay. Results: A total of 4552 patients met inclusion criteria, of which 1102 (24.2%) had non-home discharge. Multivariate regression revealed total relative value unit (odds ratio [OR] = 1.01, 95% confidence interval [CI] = 1.00-1.01); female sex (OR = 1.54, 95% CI = 1.32-1.81); American Indian, Alaska Native, Asian, Native Hawaiian, or Pacific Islander versus black race (OR = 0.52, 95% CI = 0.35-0.78, P = .002); age ≥65 years (OR = 3.72, 95% CI = 3.19-4.35); obesity (OR = 1.18, 95% CI = 1.01-1.38, P = .034); partially/totally functionally dependent (OR = 2.11, 95% CI = 1.49-2.99); osteotomy (OR = 1.42, 95% CI = 1.12-1.80, P = .004) pelvis fixation (OR = 2.38, 95% CI = 1.82-3.11); operation time ≥4 hours (OR = 1.74, 95% CI = 1.47-2.05); recent weight loss (OR = 7.66, 95% CI = 1.52-38.65; P = .014); and American Society of Anesthesiologists class ≥3 (OR = 1.80, 95% CI = 1.53-2.11) as predictors of non-home discharge. P values were
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Objectives: Adult spinal deformity (ASD) surgery encompasses a wide variety of spinal disorders and is associated with a morbidity rate between 20% and 80%. The utilization of spinal surgery has increased and this trend is expected to continue. To effectively deal with an increasing patient volume, identifying variables associated with patient discharge destination can expedite placement and reduce length of stay. Methods: The 2013-2014 American College of Surgeons National Surgical Quality Improvement Program database was queried using Current Procedural Terminology and International Classification of Diseases, Ninth Revision diagnosis codes relevant to ASD. Patients were divided based on discharge destination. Bivariate and multivariate logistic regression analyses were employed to identify predictors for patient discharge destination and hospital length of stay. Results: A total of 4552 patients met inclusion criteria, of which 1102 (24.2%) had non-home discharge. Multivariate regression revealed total relative value unit (odds ratio [OR] = 1.01, 95% confidence interval [CI] = 1.00-1.01); female sex (OR = 1.54, 95% CI = 1.32-1.81); American Indian, Alaska Native, Asian, Native Hawaiian, or Pacific Islander versus black race (OR = 0.52, 95% CI = 0.35-0.78, P = .002); age ≥65 years (OR = 3.72, 95% CI = 3.19-4.35); obesity (OR = 1.18, 95% CI = 1.01-1.38, P = .034); partially/totally functionally dependent (OR = 2.11, 95% CI = 1.49-2.99); osteotomy (OR = 1.42, 95% CI = 1.12-1.80, P = .004) pelvis fixation (OR = 2.38, 95% CI = 1.82-3.11); operation time ≥4 hours (OR = 1.74, 95% CI = 1.47-2.05); recent weight loss (OR = 7.66, 95% CI = 1.52-38.65; P = .014); and American Society of Anesthesiologists class ≥3 (OR = 1.80, 95% CI = 1.53-2.11) as predictors of non-home discharge. P values were &lt;.001 unless otherwise noted. Additionally, multivariate regression found non-home discharge to be a significant variable in prolonged length of stay. Conclusions: The authors suggest these results can be used to inform patients preoperatively of expected discharge destination, anticipate patient discharge needs postoperatively, and reduce health care costs and morbidity associated with prolonged LOS.</description><identifier>ISSN: 2192-5682</identifier><identifier>EISSN: 2192-5690</identifier><identifier>DOI: 10.1177/2192568217717971</identifier><identifier>PMID: 29796375</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Back surgery ; Original ; Patients ; Terminology</subject><ispartof>Global spine journal, 2018-05, Vol.8 (3), p.266-272</ispartof><rights>The Author(s) 2017</rights><rights>The Author(s) 2017. This work is licensed under the Creative Commons Attribution – Non-Commercial – No Derivatives License http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). 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Manuscript content on this site is licensed under Creative Commons Licenses</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c528t-db8af09d58771d6561557d41ef39c18937099797d6087b85365599d13a50118b3</citedby><cites>FETCH-LOGICAL-c528t-db8af09d58771d6561557d41ef39c18937099797d6087b85365599d13a50118b3</cites><orcidid>0000-0003-3826-1786</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5958482/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2313743262?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,21965,25752,27852,27923,27924,37011,37012,44589,44944,45332,53790,53792</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29796375$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Di Capua, John</creatorcontrib><creatorcontrib>Somani, Sulaiman</creatorcontrib><creatorcontrib>Lugo-Fagundo, Nahyr</creatorcontrib><creatorcontrib>Kim, Jun S.</creatorcontrib><creatorcontrib>Phan, Kevin</creatorcontrib><creatorcontrib>Lee, Nathan J.</creatorcontrib><creatorcontrib>Kothari, Parth</creatorcontrib><creatorcontrib>Shin, John</creatorcontrib><creatorcontrib>Cho, Samuel K.</creatorcontrib><title>Predictors for Non-Home Patient Discharge Following Elective Adult Spinal Deformity Surgery</title><title>Global spine journal</title><addtitle>Global Spine J</addtitle><description>Study Design: Retrospective cohort study. 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subjects Back surgery
Original
Patients
Terminology
title Predictors for Non-Home Patient Discharge Following Elective Adult Spinal Deformity Surgery
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