Objective

In various spinal surgeries, non-routine discharges have been associated with inferior outcomes. However, there exists a paucity of data regarding the relationship between non-routine discharge and quality of care among patients with spondylolisthesis. The aim of this study was to identify independent predictors for non-routine discharge following spinal decompression and fusion for lumbar spondylolisthesis.

Methods

A retrospective cohort study was performed using the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database from 2010 through 2016. Adult patients (≥18 years old) who underwent spinal decompression and fusion for lumbar spondylolisthesis were identified using ICD-9-CM diagnosis and CPT procedural coding systems. The study population was divided into two cohorts based on discharge disposition: routine (RD) and non-routine discharge (NRD). Patient demographics, comorbidities, adverse events, LOS, reoperation, and readmission were assessed. A multivariate logistic regression model was used to identify the independent predictors of non-home discharge and 30-day unplanned readmission.

Results

A total of 5252 patients were identified, of which 4316 (82.2%) had a RD and 936 (18.8%) had a NRD. The NRD cohort tended to be older (p < 0.001) and have a higher BMI (p < 0.001). Patients who experienced a NRD had a longer LOS (NRD: 4.7 ± 3.7 days vs RD: 3.1 ± 2.0 days, p < 0.001), a higher proportion of adverse events (p < 0.001), higher rates of reoperation (p = 0.005) and unplanned 30-day readmission rates (p < 0.001). On multivariate regression analysis, age [OR: 1.08, 95% CI (1.06–1.10), p < 0.001], female sex [OR: 2.01, 95% (1.51–2.69), p < 0.001], non-Hispanic Black race/ethnicity [OR: 2.10, 95% CI (1.36–3.24), p = 0.001], BMI [OR: 1.03, 95% CI (1.01–1.05), p = 0.007], dependent functional status [OR: 3.33, 95% CI (1.59 – 6.99), p = 0.001], malnourishment [OR: 2.14, 95% CI (1.27–3.62), p = 0.005], and LOS [OR: 1.26, 95% CI (1.18–1.33), p < 0.001] were all independent predictors for NRD. However, NRD did not independently predict an unplanned 30-day readmission on multivariate analysis.

Conclusion

In our study we found that on univariate analysis NRD was associated with increased adverse events, length of stay and 30-day unplanned readmission. When controlling for patient- and hospital-related factors, we found that female sex, non-Hispanic Black race, BMI, dependent functional status, malnourishment and longer LOS were independently associated with NRD. However, NRD did not independently predict an unplanned 30-day readmission.

中文翻译：

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腰椎滑脱腰椎减压融合术后非常规出院的患者和医院相关危险因素

客观的

在各种脊柱手术中，非常规出院与较差的结果有关。然而，关于脊椎滑脱患者非常规出院与护理质量之间关系的数据很少。本研究的目的是确定腰椎滑脱脊柱减压融合术后非常规出院的独立预测因素。

方法

从 2010 年到 2016 年，使用美国外科学院 (ACS) 国家手术质量改进计划 (NSQIP) 数据库进行了一项回顾性队列研究。使用 ICD 确定了接受脊柱减压和融合治疗腰椎滑脱的成年患者（≥18 岁） -9-CM 诊断和 CPT 程序编码系统。研究人群根据出院情况分为两组：常规（RD）和非常规出院（NRD）。评估了患者的人口统计学、合并症、不良事件、LOS、再手术和再入院。使用多变量逻辑回归模型来确定非居家出院和 30 天计划外再入院的独立预测因素。

结果

共确定了 5252 名患者，其中 4316 名（82.2%）患有 RD，936 名（18.8%）患有 NRD。NRD 队列往往年龄较大 ( p < 0.001 ) 且 BMI 较高 ( p < 0.001 )。经历 NRD 的患者 LOS 更长（NRD：4.7 ± 3.7 天 vs RD：3.1 ± 2.0 天，p < 0.001），不良事件比例更高（p < 0.001），再手术率更高（p = 0.005）和计划外的 30 天再入院率 ( p < 0.001 )。在多元回归分析中，年龄 [OR: 1.08, 95% CI (1.06–1.10), p < 0.001 ]，女性 [OR: 2.01, 95% (1.51–2.69), p < 0.001 ]，非西班牙裔黑人种族/种族[或：2.10, 95% CI (1.36–3.24), p = 0.001 ], BMI [OR: 1.03, 95% CI (1.01–1.05), p = 0.007 ], 依赖功能状态 [OR: 3.33, 95% CI (1.59 – 6.99), p = 0.001 ], 营养不良 [OR: 2.14, 95% CI (1.27–3.62), p = 0.005 ], 和 LOS [OR: 1.26, 95% CI (1.18–1.33), p < 0.001 ] NRD 的独立预测因子。然而，NRD 并未独立预测多变量分析中计划外的 30 天再入院。

结论

在我们的研究中，我们发现单变量分析 NRD 与不良事件增加、住院时间和 30 天计划外再入院有关。在控制患者和医院相关因素时，我们发现女性、非西班牙裔黑人种族、BMI、依赖功能状态、营养不良和较长的 LOS 与 NRD 独立相关。然而，NRD 并未独立预测计划外的 30 天再入院。