153 - Patient Characteristics Affecting Discharge Disposition after Lumbar F...

#153 Patient Characteristics Affecting Discharge Disposition after Lumbar 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: Lumbar fusion (LF) is commonly utilized to treat degenerative disorders of the lumbar spine. The purpose of this study was to analyze patient characteristics, comorbidities, and outcomes that influence the discharge disposition following a LF.

Methods: The Nationwide Inpatient Sample (NIS) database was queried from 2002-2011. Patients undergoing an elective LF to treat degenerative lumbar pathology were identified and separated into three cohorts based upon the discharge disposition (home vs home with healthcare vs outside facility). Patient demographics, comorbidities (CCI), length of stay (LOS) and costs were compared between the 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 discharge to another facility while controlling for age, comorbidities and hospital characteristics. A p-value < 0.001 denoted statistical significance.

Results: A total of 263,873 LF's were identified of which, 190,330 (72.1%) were discharged home, 36,327 (13.8%) were discharged home with healthcare and 37,216 (14.1%) were discharged to an outside facility. The outside facility cohort was significantly older and demonstrated a greater comorbidity burden (p< 0.001). In addition, patients discharged to an outside facility were associated with a greater number of fusion levels and incurred a significantly greater LOS, total hospital costs, and postoperative complications. Regression analysis demonstrated that age >65 years, non-Caucasian ethnicity, common chronic conditions (hypertension, diabetes, depression, congestive heart failure, etc), psycho-neurological conditions, drug abuse, and large urban hospitals were independent risk factors for discharge to an outside facility. Lastly, postoperative pulmonary embolism (PE), deep vein thrombosis (DVT), infections, cardiac events, hematomas, neurological complications, urinary tract infections (UTI), ileus, delirium and hemorrhagic anemia significantly increased the risk of being discharged to an outside facility.

Conclusion: After a lumbar fusion, 14.1% of patients were discharged to an outside facility. This study identified the perioperative parameters that increase the risk for discharge to an outside facility. Further research is warranted to demonstrate if preoperative optimization of these risk factors may reduce the need for additional postoperative care following a lumbar spinal fusion.