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Posterior Cervical Decompression and Fusion: Assessing Risk Factors for Nonhome Discharge and the Impact of Disposition on Postdischarge Outcomes.
World Neurosurg. 2019 05; 125:e958-e965.WN

Abstract

BACKGROUND

The purpose of this study was to identify predictors for postacute care facility discharge for patients undergoing posterior cervical decompression and fusion (PCDF) and to determine if discharge placement impacts postdischarge outcomes.

METHODS

Patients undergoing PCDF from 2012 to 2015 were queried from the NSQIP database (n = 8743) and separated by discharge placement. Outcomes included nonhome discharge, unplanned 30-day readmission, and adverse events (AEs), both before and after discharge. Demographics and comorbidities were analyzed using bivariate analysis. Multivariate logistic regression was used to identify predictors for nonhome discharge, readmission, and severe AE after discharge.

RESULTS

Patients with nonhome discharges were significantly older (67.4 vs. 58.6 years; P < 0.001), sicker (82% vs. 54% American Society of Anesthesiologists >2; P < 0.001), and more functionally dependent (16% vs. 3.4%; P < 0.001), with a greater comorbidity burden. Patients with PCDF had an increased likelihood of nonhome discharge if they had a dependent functional status (odds ratio [OR], 2.99; 95% confidence interval [CI], 2.33-3.82; P < 0.001), diabetes (OR, 1.32; 95% CI, 1.13-1.55; P = 0.0007), and an American Society of Anesthesiologists >2 (OR, 1.75; 95% CI, 1.5-2.05; P < 0.001), as well as if they were older (OR, 1.06; 95% CI, 1.05-1.06; P < 0.001) and female (OR, 1.31; 95% CI, 1.14-1.5; P = 0.0002). Patients with PCDF with nonhome discharges had an increased likelihood of having a severe postdischarge AE (OR, 1.71; 95% CI, 1.26-2.33; P = 0.0006) and an unplanned readmission (OR, 1.45; 95% CI, 1.15-1.82; P = 0.002).

CONCLUSIONS

Results of this cross-sectional study suggest that patients with PCDF discharged to a postacute care facility have a higher likelihood of having a severe AE after discharge as well as a higher likelihood of being readmitted.

Authors+Show Affiliations

Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA. Electronic address: Daniel.Snyder@Icahn.Mssm.Edu.Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA.Department of Anesthesiology, Perioperative and Pain Medicine, Mount Sinai Hospital, New York, New York, USA.Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA.Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA; Department of Orthopedics, Mount Sinai Hospital, New York, New York, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30763752

Citation

Snyder, Daniel J., et al. "Posterior Cervical Decompression and Fusion: Assessing Risk Factors for Nonhome Discharge and the Impact of Disposition On Postdischarge Outcomes." World Neurosurgery, vol. 125, 2019, pp. e958-e965.
Snyder DJ, Neifert SN, Gal JS, et al. Posterior Cervical Decompression and Fusion: Assessing Risk Factors for Nonhome Discharge and the Impact of Disposition on Postdischarge Outcomes. World Neurosurg. 2019;125:e958-e965.
Snyder, D. J., Neifert, S. N., Gal, J. S., Deutsch, B. C., & Caridi, J. M. (2019). Posterior Cervical Decompression and Fusion: Assessing Risk Factors for Nonhome Discharge and the Impact of Disposition on Postdischarge Outcomes. World Neurosurgery, 125, e958-e965. https://doi.org/10.1016/j.wneu.2019.01.214
Snyder DJ, et al. Posterior Cervical Decompression and Fusion: Assessing Risk Factors for Nonhome Discharge and the Impact of Disposition On Postdischarge Outcomes. World Neurosurg. 2019;125:e958-e965. PubMed PMID: 30763752.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Posterior Cervical Decompression and Fusion: Assessing Risk Factors for Nonhome Discharge and the Impact of Disposition on Postdischarge Outcomes. AU - Snyder,Daniel J, AU - Neifert,Sean N, AU - Gal,Jonathan S, AU - Deutsch,Brian C, AU - Caridi,John M, Y1 - 2019/02/11/ PY - 2018/10/13/received PY - 2019/01/21/revised PY - 2019/01/22/accepted PY - 2019/2/15/pubmed PY - 2019/12/28/medline PY - 2019/2/15/entrez KW - Bundled payments KW - Episode-based outcomes KW - Nonhome discharge KW - Outcomes KW - SNF KW - Unplanned readmission SP - e958 EP - e965 JF - World neurosurgery JO - World Neurosurg VL - 125 N2 - BACKGROUND: The purpose of this study was to identify predictors for postacute care facility discharge for patients undergoing posterior cervical decompression and fusion (PCDF) and to determine if discharge placement impacts postdischarge outcomes. METHODS: Patients undergoing PCDF from 2012 to 2015 were queried from the NSQIP database (n = 8743) and separated by discharge placement. Outcomes included nonhome discharge, unplanned 30-day readmission, and adverse events (AEs), both before and after discharge. Demographics and comorbidities were analyzed using bivariate analysis. Multivariate logistic regression was used to identify predictors for nonhome discharge, readmission, and severe AE after discharge. RESULTS: Patients with nonhome discharges were significantly older (67.4 vs. 58.6 years; P < 0.001), sicker (82% vs. 54% American Society of Anesthesiologists >2; P < 0.001), and more functionally dependent (16% vs. 3.4%; P < 0.001), with a greater comorbidity burden. Patients with PCDF had an increased likelihood of nonhome discharge if they had a dependent functional status (odds ratio [OR], 2.99; 95% confidence interval [CI], 2.33-3.82; P < 0.001), diabetes (OR, 1.32; 95% CI, 1.13-1.55; P = 0.0007), and an American Society of Anesthesiologists >2 (OR, 1.75; 95% CI, 1.5-2.05; P < 0.001), as well as if they were older (OR, 1.06; 95% CI, 1.05-1.06; P < 0.001) and female (OR, 1.31; 95% CI, 1.14-1.5; P = 0.0002). Patients with PCDF with nonhome discharges had an increased likelihood of having a severe postdischarge AE (OR, 1.71; 95% CI, 1.26-2.33; P = 0.0006) and an unplanned readmission (OR, 1.45; 95% CI, 1.15-1.82; P = 0.002). CONCLUSIONS: Results of this cross-sectional study suggest that patients with PCDF discharged to a postacute care facility have a higher likelihood of having a severe AE after discharge as well as a higher likelihood of being readmitted. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/30763752/Posterior_Cervical_Decompression_and_Fusion:_Assessing_Risk_Factors_for_Nonhome_Discharge_and_the_Impact_of_Disposition_on_Postdischarge_Outcomes_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(19)30326-2 DB - PRIME DP - Unbound Medicine ER -