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Predictors of a Non-Home Discharge Destination following Spinal Fusion for Adolescent Idiopathic Scoliosis (AIS).
Spine 2018 September 22
STUDY DESIGN: Retrospective cohort study.
OBJECTIVE: Analyze risk factors associated with a non-home discharge following spinal fusions in adolescent idiopathic scoliosis (AIS).
SUMMARY OF BACKGROUND DATA: Current evidence is limited with regard to which patient-level and provider/hospital-level factors predict a non-home discharge disposition following spinal fusions in AIS. Identifying these factors can allow providers to identify which patients would ultimately require facility care and can be discharged early to these facilities to reduce hospital costs.
METHODS: The 2012-2016 American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) Pediatric database was queried using Current Procedural Terminology codes for posterior spinal fusions (22800, 22802, and 22804) and anterior spinal fusions (22808, 22810 and 22812). Patients were categorized into those receiving a posterior-only fusion, anterior-only fusion and combined anterior-posterior fusion. Only patients aged 10-18 undergoing corrective surgery for idiopathic scoliosis were included in the study.
RESULTS: Out of a total of 8,452 patients - 90 (1.1%) were discharged to a destination other than home (skilled-care facility, separate acute care unit and/or rehabilitation unit). Following multi-variate analysis, children with a BMI of 20-30 (p = 0.002) or >30 (p = 0.003), structural pulmonary abnormality (p = 0.030), past history of childhood cancer (p = 0.018), an ASA grade >II (p<0.001), undergoing a revision surgery vs. a primary surgery (p = 0.039), a length of stay >4 days (p<0.001) and the occurrence of a pre-discharge complication (p = 0.003) were independent predictors associated with a non-home discharge disposition.
CONCLUSIONS: In the current era of evolving health-care in which there is an increased focus toward decreasing costs, providers should consider utilizing these data to pre-operatively identify patients who can be discharged to facility, and tailor an appropriate post-operative course of care aimed at expediting discharge processes to curb the financial burden of a prolonged length of stay.
LEVEL OF EVIDENCE: 3.
OBJECTIVE: Analyze risk factors associated with a non-home discharge following spinal fusions in adolescent idiopathic scoliosis (AIS).
SUMMARY OF BACKGROUND DATA: Current evidence is limited with regard to which patient-level and provider/hospital-level factors predict a non-home discharge disposition following spinal fusions in AIS. Identifying these factors can allow providers to identify which patients would ultimately require facility care and can be discharged early to these facilities to reduce hospital costs.
METHODS: The 2012-2016 American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) Pediatric database was queried using Current Procedural Terminology codes for posterior spinal fusions (22800, 22802, and 22804) and anterior spinal fusions (22808, 22810 and 22812). Patients were categorized into those receiving a posterior-only fusion, anterior-only fusion and combined anterior-posterior fusion. Only patients aged 10-18 undergoing corrective surgery for idiopathic scoliosis were included in the study.
RESULTS: Out of a total of 8,452 patients - 90 (1.1%) were discharged to a destination other than home (skilled-care facility, separate acute care unit and/or rehabilitation unit). Following multi-variate analysis, children with a BMI of 20-30 (p = 0.002) or >30 (p = 0.003), structural pulmonary abnormality (p = 0.030), past history of childhood cancer (p = 0.018), an ASA grade >II (p<0.001), undergoing a revision surgery vs. a primary surgery (p = 0.039), a length of stay >4 days (p<0.001) and the occurrence of a pre-discharge complication (p = 0.003) were independent predictors associated with a non-home discharge disposition.
CONCLUSIONS: In the current era of evolving health-care in which there is an increased focus toward decreasing costs, providers should consider utilizing these data to pre-operatively identify patients who can be discharged to facility, and tailor an appropriate post-operative course of care aimed at expediting discharge processes to curb the financial burden of a prolonged length of stay.
LEVEL OF EVIDENCE: 3.
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