title: Risk Factors for Nonroutine Discharge in Patients Undergoing Spinal Fusion for Intervertebral Disc Disorders.
abstract: BACKGROUND
  Although outcomes following spinal fusion for intervertebral disc disorders have been studied, factors influencing discharge disposition and health care resource utilization have not been determined. This study sought to clarify perioperative risk factors for non-routine discharge and prolonged hospital stay in patients undergoing fusion for intervertebral disc disorders.
  
  
  METHODS
  The National Hospital Discharge Survey was queried to identify all patients discharged from U.S. hospitals following spinal fusion for intervertebral disc disorders between 1990 and 2007. A cohort representative of 1,943,707 patients was identified and separated into those who were discharged home and those who were discharged to rehabilitation facilities. Multivariable logistic regression analysis was used to identify independent predictors of non-routine discharge to another inpatient facility and prolonged hospital stay.
  
  
  RESULTS
  The strongest risk factors for non-routine discharge were age>65 years, congestive heart failure, atrial fibrillation, any general in-hospital complication, diabetes mellitus, osteoporosis, hypertension and any surgery-related complication. Patients younger than 50 years and males had the lowest rate of non-routine discharge. The strongest risk factors for prolonged hospital stay were any surgery-related complication, congestive heart failure, any general in-hospital complication, atrial fibrillation, age > 65 years, osteoporosis and diabetes mellitus. Patients 36-50 years of age had the lowest risk of increased length of hospital stay.
  
  
  CONCLUSIONS
  Knowledge of these risk factors may aid in better resource allocation and improved strategies for managing patients with spondylosis in order to decrease healthcare costs.
  
  
  METHODS
  3.
authors.affiliation: University of Miami Miller School of Medicine, Department of Orthopaedic Surgery and Rehabilitation , 1400 NW 12th Avenue, Miami, FL 33136 , USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Best
authors.affiliation: University of Miami Miller School of Medicine, Department of Orthopaedic Surgery and Rehabilitation , 1400 NW 12th Avenue, Miami, FL 33136 , USA.
authors.forename: Leonard T
authors.initials: LT
authors.lastname: Buller
authors.affiliation: University of Miami Miller School of Medicine, Department of Orthopaedic Surgery and Rehabilitation , 1400 NW 12th Avenue, Miami, FL 33136 , USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Falakassa
authors.affiliation: University of Miami Miller School of Medicine, Department of Orthopaedic Surgery and Rehabilitation , 1400 NW 12th Avenue, Miami, FL 33136 , USA.
authors.forename: David
authors.initials: D
authors.lastname: Vecchione
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D003266:Continuity of Patient Care; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D007405:Intervertebral Disc Displacement / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010351:Patient Discharge / Q000706:statistics & numerical data* / Q000639:trends; D011182:Postoperative Care; D011237:Predictive Value of Tests; D012047:Rehabilitation Centers; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods* / Q000534:rehabilitation; D014481:United States
keywords: comorbidities; discharge; epidemiology; hospital stay; intervertebral disc disorder; length of stay; post-hospitalization care; spinal fusion