Risk factors for nonroutine discharge in adult spinal deformity surgery.
Adult
Aged
Female
Humans
Length of Stay
/ statistics & numerical data
Male
Middle Aged
Neurosurgical Procedures
/ adverse effects
Osteotomy
/ adverse effects
Patient Discharge
/ statistics & numerical data
Patient Reported Outcome Measures
Postoperative Complications
/ epidemiology
Scoliosis
/ surgery
3-column osteotomy
Adult spinal deformity
Blood transfusion
Charlson Comorbidity Index
Osteoporosis
Spinal arthrodesis
Journal
The spine journal : official journal of the North American Spine Society
ISSN: 1878-1632
Titre abrégé: Spine J
Pays: United States
ID NLM: 101130732
Informations de publication
Date de publication:
02 2019
02 2019
Historique:
received:
23
03
2018
revised:
29
06
2018
accepted:
29
06
2018
entrez:
22
1
2019
pubmed:
22
1
2019
medline:
18
12
2019
Statut:
ppublish
Résumé
Surgery for adult spinal deformity (ASD) is increasingly common. Although outcomes of ASD surgery have been studied extensively, to our knowledge, no data exist regarding factors predicting nonroutine discharge in this population. Nonroutine discharge is defined as discharge to a health care facility after surgery rather than to home. To determine which patient and surgical factors predict nonroutine discharge after ASD surgery. This is a retrospective study. We conducted a retrospective single-center study of 303 patients who underwent arthrodesis of five or more spinal levels to treat ASD between 2009 and 2014. Patients were stratified into two groups according to discharge disposition: home or nonroutine. Objective preoperative characteristics, intraoperative course, and postoperative recovery were analyzed to identify pre- and perioperative factors associated with nonroutine discharge. Univariate analysis was performed first. All factors with P values < .2 on univariate analysis were included in a logistic regression model. Additionally, to understand the relationship between subjective patient-reported outcome measures and nonroutine discharge, we compared the two groups with respect to mean Oswestry Disability Index and Scoliosis Research Society-22r domains using Student t-tests. On univariate analysis, objective measures that differed significantly (P < .05) between the two cohorts were age (≥65 years), osteoporosis, Charlson Comorbidity Index score of ≥2, prolonged hospital stay (>8 days), and blood transfusion. Given the above logistic regression inclusion criteria, we controlled for the performance, and type, of osteotomy (P = .055). On multivariate analysis, older age, osteoporosis, prolonged hospital stay, blood transfusion, and 3-column osteotomy were independently associated with nonroutine discharge. Subjective patient-reported outcome measures, including Oswestry Disability Index and Scoliosis Research Society-22r physical function and pain domain scores, were significantly worse in the nonroutine discharge cohort (P < .05). To our knowledge, this is the first study to evaluate pre- and perioperative factors associated with nonroutine discharge after ASD surgery. Elderly patients who undergo complex surgery and receive blood transfusions are at particularly high risk of nonroutine discharge. Surgeons should consider these factors during surgical planning and preoperative patient counseling.
Sections du résumé
BACKGROUND CONTEXT
Surgery for adult spinal deformity (ASD) is increasingly common. Although outcomes of ASD surgery have been studied extensively, to our knowledge, no data exist regarding factors predicting nonroutine discharge in this population. Nonroutine discharge is defined as discharge to a health care facility after surgery rather than to home.
PURPOSE
To determine which patient and surgical factors predict nonroutine discharge after ASD surgery.
DESIGN
This is a retrospective study.
PATIENTS SAMPLE
We conducted a retrospective single-center study of 303 patients who underwent arthrodesis of five or more spinal levels to treat ASD between 2009 and 2014.
OUTCOME MEASURES
Patients were stratified into two groups according to discharge disposition: home or nonroutine.
METHODS
Objective preoperative characteristics, intraoperative course, and postoperative recovery were analyzed to identify pre- and perioperative factors associated with nonroutine discharge. Univariate analysis was performed first. All factors with P values < .2 on univariate analysis were included in a logistic regression model. Additionally, to understand the relationship between subjective patient-reported outcome measures and nonroutine discharge, we compared the two groups with respect to mean Oswestry Disability Index and Scoliosis Research Society-22r domains using Student t-tests.
RESULTS
On univariate analysis, objective measures that differed significantly (P < .05) between the two cohorts were age (≥65 years), osteoporosis, Charlson Comorbidity Index score of ≥2, prolonged hospital stay (>8 days), and blood transfusion. Given the above logistic regression inclusion criteria, we controlled for the performance, and type, of osteotomy (P = .055). On multivariate analysis, older age, osteoporosis, prolonged hospital stay, blood transfusion, and 3-column osteotomy were independently associated with nonroutine discharge. Subjective patient-reported outcome measures, including Oswestry Disability Index and Scoliosis Research Society-22r physical function and pain domain scores, were significantly worse in the nonroutine discharge cohort (P < .05).
CONCLUSION
To our knowledge, this is the first study to evaluate pre- and perioperative factors associated with nonroutine discharge after ASD surgery. Elderly patients who undergo complex surgery and receive blood transfusions are at particularly high risk of nonroutine discharge. Surgeons should consider these factors during surgical planning and preoperative patient counseling.
Identifiants
pubmed: 30661516
pii: S1529-9430(18)30645-4
doi: 10.1016/j.spinee.2018.06.366
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
357-363Informations de copyright
Copyright © 2018 Elsevier Inc. All rights reserved.