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Discharge to Inpatient Care Facility After Vertebroplasty/Kyphoplasty: Incidence, Risk Factors, and Postdischarge Outcomes.
World Neurosurg. 2018 Oct; 118:e483-e488.WN

Abstract

INTRODUCTION

Vertebral compression fractures are a common clinical occurrence in elderly individuals with osteoporosis. No current evidence exists on risk factors and clinical impact of discharge to inpatient (IP) care facility after vertebral augmentation procedures.

MATERIALS AND METHODS

The 2012-2014 American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database files were queried using Current Procedural Terminology codes for vertebroplasty (22520, 22521, and 22522) and kyphoplasty (22523, 22524, and 22525). Discharge to IP care facility included skilled-care facilities and IP rehabilitation units. A total of 2361 patients were included in the final cohort.

RESULTS

Of 2361 patients, 1962 (83.1%) were discharged home and 399 (16.9%) were discharged to an IP care facility. Multivariate analysis identified age ≥65 years (P < 0.001), dependent preoperative functional health status (P < 0.001), hypertension (P = 0.001), preoperative transfusion (P = 0.043), IP admission status (P < 0.001), thoracolumbar procedure versus thoracic-only procedure (P = 0.012), and length of stay >1 day (P < 0.001) to be significant predictors for a discharge to an IP care facility. In addition, discharge to an IP care facility was associated with a significant greater risk of 30-day mortality (P = 0.001). No significant associations were found with between IP-care discharge destination and any 30-day complication, 30-day readmission, and 30-day reoperation.

CONCLUSIONS

Discharge to IP care facilities after vertebroplasty/kyphoplasty is associated with a 3.6 times greater odds of mortality as compared with home discharge. Providers can use the risk profile data to better allow preoperative stratification of patients to ensure that discharge location is appropriate to a patient's need to minimize the risk of adverse outcomes.

Authors+Show Affiliations

Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA. Electronic address: Safdar.Khan@osumc.edu.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

30257300

Citation

Crouser, Nisha, et al. "Discharge to Inpatient Care Facility After Vertebroplasty/Kyphoplasty: Incidence, Risk Factors, and Postdischarge Outcomes." World Neurosurgery, vol. 118, 2018, pp. e483-e488.
Crouser N, Malik AT, Jain N, et al. Discharge to Inpatient Care Facility After Vertebroplasty/Kyphoplasty: Incidence, Risk Factors, and Postdischarge Outcomes. World Neurosurg. 2018;118:e483-e488.
Crouser, N., Malik, A. T., Jain, N., Yu, E., Kim, J., & Khan, S. N. (2018). Discharge to Inpatient Care Facility After Vertebroplasty/Kyphoplasty: Incidence, Risk Factors, and Postdischarge Outcomes. World Neurosurgery, 118, e483-e488. https://doi.org/10.1016/j.wneu.2018.06.221
Crouser N, et al. Discharge to Inpatient Care Facility After Vertebroplasty/Kyphoplasty: Incidence, Risk Factors, and Postdischarge Outcomes. World Neurosurg. 2018;118:e483-e488. PubMed PMID: 30257300.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Discharge to Inpatient Care Facility After Vertebroplasty/Kyphoplasty: Incidence, Risk Factors, and Postdischarge Outcomes. AU - Crouser,Nisha, AU - Malik,Azeem Tariq, AU - Jain,Nikhil, AU - Yu,Elizabeth, AU - Kim,Jeffery, AU - Khan,Safdar N, Y1 - 2018/07/06/ PY - 2018/05/24/received PY - 2018/06/25/revised PY - 2018/06/27/accepted PY - 2018/9/28/entrez PY - 2018/9/28/pubmed PY - 2018/10/20/medline KW - Discharge destination KW - Kyphoplasty KW - NSQIP KW - Outcomes KW - Vertebral augmentation KW - Vertebral fractures KW - Vertebroplasty SP - e483 EP - e488 JF - World neurosurgery JO - World Neurosurg VL - 118 N2 - INTRODUCTION: Vertebral compression fractures are a common clinical occurrence in elderly individuals with osteoporosis. No current evidence exists on risk factors and clinical impact of discharge to inpatient (IP) care facility after vertebral augmentation procedures. MATERIALS AND METHODS: The 2012-2014 American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database files were queried using Current Procedural Terminology codes for vertebroplasty (22520, 22521, and 22522) and kyphoplasty (22523, 22524, and 22525). Discharge to IP care facility included skilled-care facilities and IP rehabilitation units. A total of 2361 patients were included in the final cohort. RESULTS: Of 2361 patients, 1962 (83.1%) were discharged home and 399 (16.9%) were discharged to an IP care facility. Multivariate analysis identified age ≥65 years (P < 0.001), dependent preoperative functional health status (P < 0.001), hypertension (P = 0.001), preoperative transfusion (P = 0.043), IP admission status (P < 0.001), thoracolumbar procedure versus thoracic-only procedure (P = 0.012), and length of stay >1 day (P < 0.001) to be significant predictors for a discharge to an IP care facility. In addition, discharge to an IP care facility was associated with a significant greater risk of 30-day mortality (P = 0.001). No significant associations were found with between IP-care discharge destination and any 30-day complication, 30-day readmission, and 30-day reoperation. CONCLUSIONS: Discharge to IP care facilities after vertebroplasty/kyphoplasty is associated with a 3.6 times greater odds of mortality as compared with home discharge. Providers can use the risk profile data to better allow preoperative stratification of patients to ensure that discharge location is appropriate to a patient's need to minimize the risk of adverse outcomes. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/30257300/Discharge_to_Inpatient_Care_Facility_After_Vertebroplasty/Kyphoplasty:_Incidence_Risk_Factors_and_Postdischarge_Outcomes_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(18)31437-2 DB - PRIME DP - Unbound Medicine ER -