Discharge to a rehabilitation facility is associated with decreased 30-day readmission in elective spinal surgery.
The aim of our study was to determine independent predictors of discharge disposition to rehabilitation or skilled care (SC) facilities and investigate whether discharge location is associated with unplanned readmission and/or reoperation rates. All elective spinal surgery patients in a national surgical registry were analyzed using between 2011 and 2012. Multivariable logistic regression analysis was used to assess for predictors of discharge to rehabilitation or SC facilities versus home as well as to determine whether discharge disposition was significantly associated with the 30-day unplanned readmission or reoperation. Of 34,023 elective spinal surgery patients, the distribution of discharge locations was as follows: 30,606 (90.0%) discharged home, 1674 (4.9%) discharged to rehabilitation, and 1743 (5.1%) discharged to SC. Patients discharged home were associated with the lowest complication rate relative to rehabilitation and SC facilities. Following multivariable regression analysis, there was a significant increase in the odds of discharge to rehabilitation associated with age, male gender, current smoking, ASA class three and four, history of diabetes, operative time, total hospital length of stay, preoperative neurologic morbidity and having at least one postoperative morbidity event. Moreover, there were 804 (4.06%) 30-day unplanned readmissions and 822 (2.45%) unplanned reoperations. After risk adjustment, discharge to rehabilitation was independently associated with decreased odds of 30-day unplanned readmission (OR=0.41; p=0.008) but not reoperation.
Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA.
Nicholas B
NB
Abt
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Mayo Clinic Neuro-Informatics Laboratory, Rochester, MN, USA.
Brandon A
BA
McCutcheon
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Mayo Clinic Neuro-Informatics Laboratory, Rochester, MN, USA.
Panagiotis
P
Kerezoudis
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Mayo Clinic Neuro-Informatics Laboratory, Rochester, MN, USA.
Meghan
M
Murphy
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Mayo Clinic Neuro-Informatics Laboratory, Rochester, MN, USA.
Lorenzo
L
Rinaldo
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
Jeremy
J
Fogelson
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
Ahmad
A
Nassr
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
Bradford L
BL
Currier
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Mayo Clinic Neuro-Informatics Laboratory, Rochester, MN, USA. Electronic address: Bydon.mohamad@mayo.edu.
Mohamad
M
Bydon
D000368:Aged; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000534:rehabilitation* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012042:Registries / Q000706:statistics & numerical data; D012086:Reoperation / Q000706:statistics & numerical data; D013131:Spine / Q000601:surgery*
Discharge; Disposition; Nsqip; Readmission; Rehabilitation; Spinal surgery