Indicators for Nonroutine Discharge Following Cervical Deformity-Corrective Surgery: Radiographic, Surgical, and Patient-Related Factors. Issue 3 (8th March 2019)

• Record Type: Journal Article
• Authors: Bortz, Cole A; Passias, Peter G; Segreto, Frank; Horn, Samantha R; Lafage, Virginie; Smith, Justin S; Line, Breton; Mundis, Gregory M; Kebaish, Khaled M; Kelly, Michael P; Protopsaltis, Themistocles; Sciubba, Daniel M; Soroceanu, Alexandra; Klineberg, Eric O; Burton, Douglas C; Hart, Robert A; Schwab, Frank J; Bess, Shay; Shaffrey, Christopher I; Ames, Christopher P
• Is Part Of: Neurosurgery. Volume 85:Issue 3(2019)
• Page Start: E509
• Page End: E519
• Publication Date: 2019-03-08
• Subjects: Cervical deformity -- Surgery -- Discharge -- CD -- Rehabilitation -- Skilled nursing facility -- Outcomes; Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyz016
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: BACKGROUND: Nonroutine discharge, including discharge to inpatient rehab and skilled nursing facilities, is associated with increased cost-of-care. Given the rising prevalence of cervical deformity (CD)-corrective surgery and the necessity of value-based healthcare, it is important to identify indicators for nonroutine discharge. OBJECTIVE: To identify factors associated with nonroutine discharge after CD-corrective surgery using a statistical learning algorithm. METHODS: A retrospective review of patients ≥18 yr with discharge and baseline (BL) radiographic data. Conditional inference decision trees identified factors associated with nonroutine discharge and cut-off points at which factors were significantly associated with discharge status. A conditional variable importance table used nonreplacement sampling set of 10 000 conditional inference trees to identify influential patient/surgical factors. The binary logistic regression indicated odds of nonroutine discharge for patients with influential factors at significant cut-off points. RESULTS: Of 138 patients (61 yr, 63% female) undergoing surgery for CD (8 ± 5 levels; 49% posterior approach, 16% anterior, and 35% combined), 29% experienced nonroutine discharge. BL cervical/upper-cervical malalignment showed the strongest relationship with nonroutine discharge: C1 slope ≥ 14°, C2 slope ≥ 57°, TS-CL ≥ 57°. Patient-related factors associated with nonroutine discharge included BL gait impairment, age ≥ 59 yr and apex of CD primary driver ≥ C7. The only surgical factor associated with nonroutine discharge was fusion ≥ 8 levels. There was no relationship between nonhome discharge and reoperation within 6 mo or 1 yr (both P > .05) of index procedure. Despite no differences in BL EQ-5D ( P = .946), nonroutine discharge patients had inferior 1-yr postoperative EQ-5D scores ( P = .044). CONCLUSION: Severe preoperative cervical malalignment was strongly associated with nonroutine discharge following CD-corrective surgery. Age, deformity driver, and ≥ 8 level fusions were also associated with nonroutine discharge and should be taken into account to improve patient counseling and health care resource allocation.