152 - Patient Characteristics Affecting Discharge Disposition after Anterior...

#152 Patient Characteristics Affecting Discharge Disposition after Anterior Cervical Fusion

Epidemiology/Natural History

Poster Presented by: K. Singh

Author(s):

A.J. Marquez-Lara (1)
S.V. Nandyala (1)
S.J. Fineberg (1)
M. Noureldin (1)
K. Singh (1)

(1) Rush University Medical Center, Orthopaedic Surgery, Chicago, IL, United States

Abstract

Introduction: Anterior cervical fusion (ACF) is a safe and effective procedure that is increasingly utilized in an outpatient setting. Perioperative complications may alter the discharge disposition. The purpose of this study was to assess the perioperative factors affecting the patient's discharge disposition following an ACF procedure.

Methods: The Nationwide Inpatient Sample (NIS) database was queried from 2002-2011. Patients undergoing an elective ACF to treat degenerative cervical pathology were identified and were separated into three cohorts based upon their discharge disposition (home vs home with healthcare vs outside facility). Patient demographics, comorbidities (CCI), length of stay (LOS) and costs were compared between these cohorts. SPSS v.20 was utilized for statistical analysis with one-way ANOVA for discrete variables and χ2-tests for categorical data. Multinomial logistic regression identified the independent predictors for a discharge to an outside facility while controlling for age, comorbidities and hospital characteristics. A p-value < 0.001 denoted statistical significance.

Results: A total of 146,283 ACF procedures were identified in the NIS database between 2002-2011, of which 137,618 (94.1%) were discharged home, 5,393 (3.7%) were discharged home with healthcare, and 3,272 (2.2%) were discharged to an outside facility. The outside facility cohort was significantly older and demonstrated a greater comorbidity burden (p< 0.001). In addition, the patients discharged to an outside facility were associated with a greater number fusion levels and incurred a greater LOS and total hospital costs (p< 0.001). Furthermore, patients discharged to an outside facility demonstrated a significantly greater incidence of postoperative complications. Regression analysis demonstrated that age >65 years, non-Caucasian ethnicity, chronic conditions (hypertension, diabetes, depression, lung disease, etc), psycho-neurological conditions, drug abuse, and large teaching hospitals in an urban setting were independent risk factors for discharge to an outside facility. Lastly, postoperative deep vein thrombosis (DVT), infections, cardiac events, hematomas, neurological complications, urinary tract infections (UTI), dysphagia, aspiration, and delirium significantly increased the likelihood for discharge to an outside facility.

Conclusion: After an ACF procedure, 2.2% of patients were discharged to an outside facility. Patients who developed a postoperative complication including UTI, dysphagia, aspiration, DVT, and infection demonstrated a significantly greater risk for discharge to an outside facility. This study highlights the many perioperative parameters in the ACF population that increase the risk for discharge to an outside facility. Further studies are warranted to better characterize the impact of these parameters on patient discharge disposition following an ACF procedure.