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Discharge to Inpatient Care Facility After Anterior Lumbar Interbody Fusion: Incidence, Predictors, and Postdischarge Outcomes.
World Neurosurg. 2019 02; 122:e584-e590.WN

Abstract

BACKGROUND

Despite a significant number of patients being discharged to inpatient care facilities after anterior lumbar interbody fusion (ALIF), the current literature remains limited regarding the predictors associated with a nonhome discharge and the impact of continued inpatient care in a facility on postdischarge outcomes.

METHODS

The 2013-2016 American College of Surgeons National Surgical Quality Improvement Program was queried using Current Procedural Terminology (CPT) codes for ALIF (CPT-22558) and additional level fusions (CPT-22585). Discharge to inpatient care facilities included discharge to skilled care facilities and/or inpatient rehabilitation units.

RESULTS

Independent predictors of an inpatient care facility discharge were age older than 45 years (P < 0.001), female sex (P < 0.001), more than 10% body weight loss in the last 6 months prior to surgery (P=0.012), American Society of Anesthesiologists grade greater than II (P=0.005), undergoing a 2-level (P < 0.001) or more than 2-level fusion (P=0.017), a length of stay greater than 3 days (P < 0.001), and the occurrence of any predischarge complication (P < 0.001). After adjustment for differences in clinical and baseline characteristics between the 2 groups, discharge to an inpatient care facility after ALIF was independently associated with higher odds of any postdischarge complication (P=0.010), postdischarge wound complication (P=0.005), and postdischarge septic complications (P=0.011). No significant impact was seen on 30-day readmissions (P=0.943), 30-day reoperations (P=0.228), and 30-day mortality (P=0.913).

CONCLUSIONS

With an increasing focus toward minimizing costs associated with postacute care, providers should understand the need of appropriate preoperative risk stratification and construction of care pathways aimed at a home discharge to reduce the occurrence and/or risk of experiencing postdischarge complications.

Authors+Show Affiliations

The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.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

31108074

Citation

Malik, Azeem Tariq, et al. "Discharge to Inpatient Care Facility After Anterior Lumbar Interbody Fusion: Incidence, Predictors, and Postdischarge Outcomes." World Neurosurgery, vol. 122, 2019, pp. e584-e590.
Malik AT, Kim J, Yu E, et al. Discharge to Inpatient Care Facility After Anterior Lumbar Interbody Fusion: Incidence, Predictors, and Postdischarge Outcomes. World Neurosurg. 2019;122:e584-e590.
Malik, A. T., Kim, J., Yu, E., & Khan, S. N. (2019). Discharge to Inpatient Care Facility After Anterior Lumbar Interbody Fusion: Incidence, Predictors, and Postdischarge Outcomes. World Neurosurgery, 122, e584-e590. https://doi.org/10.1016/j.wneu.2018.10.108
Malik AT, et al. Discharge to Inpatient Care Facility After Anterior Lumbar Interbody Fusion: Incidence, Predictors, and Postdischarge Outcomes. World Neurosurg. 2019;122:e584-e590. PubMed PMID: 31108074.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Discharge to Inpatient Care Facility After Anterior Lumbar Interbody Fusion: Incidence, Predictors, and Postdischarge Outcomes. AU - Malik,Azeem Tariq, AU - Kim,Jeffery, AU - Yu,Elizabeth, AU - Khan,Safdar N, Y1 - 2018/10/26/ PY - 2018/07/05/received PY - 2018/10/15/revised PY - 2018/10/17/accepted PY - 2019/5/21/entrez PY - 2019/5/21/pubmed PY - 2019/10/15/medline KW - ALIF KW - Anterior lumbar interbody fusion KW - Discharge destination KW - Inpatient facility KW - NSQIP KW - Postdischarge SP - e584 EP - e590 JF - World neurosurgery JO - World Neurosurg VL - 122 N2 - BACKGROUND: Despite a significant number of patients being discharged to inpatient care facilities after anterior lumbar interbody fusion (ALIF), the current literature remains limited regarding the predictors associated with a nonhome discharge and the impact of continued inpatient care in a facility on postdischarge outcomes. METHODS: The 2013-2016 American College of Surgeons National Surgical Quality Improvement Program was queried using Current Procedural Terminology (CPT) codes for ALIF (CPT-22558) and additional level fusions (CPT-22585). Discharge to inpatient care facilities included discharge to skilled care facilities and/or inpatient rehabilitation units. RESULTS: Independent predictors of an inpatient care facility discharge were age older than 45 years (P < 0.001), female sex (P < 0.001), more than 10% body weight loss in the last 6 months prior to surgery (P=0.012), American Society of Anesthesiologists grade greater than II (P=0.005), undergoing a 2-level (P < 0.001) or more than 2-level fusion (P=0.017), a length of stay greater than 3 days (P < 0.001), and the occurrence of any predischarge complication (P < 0.001). After adjustment for differences in clinical and baseline characteristics between the 2 groups, discharge to an inpatient care facility after ALIF was independently associated with higher odds of any postdischarge complication (P=0.010), postdischarge wound complication (P=0.005), and postdischarge septic complications (P=0.011). No significant impact was seen on 30-day readmissions (P=0.943), 30-day reoperations (P=0.228), and 30-day mortality (P=0.913). CONCLUSIONS: With an increasing focus toward minimizing costs associated with postacute care, providers should understand the need of appropriate preoperative risk stratification and construction of care pathways aimed at a home discharge to reduce the occurrence and/or risk of experiencing postdischarge complications. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/31108074/Discharge_to_Inpatient_Care_Facility_After_Anterior_Lumbar_Interbody_Fusion:_Incidence_Predictors_and_Postdischarge_Outcomes_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(18)32406-9 DB - PRIME DP - Unbound Medicine ER -