BACKGROUND CONTEXT

Adult spinal deformity (ASD) surgery requires an extended recovery period and often non-routine discharge. The Activity Measure for Post-Acute Care (AM-PAC) Basic Mobility Inpatient Short Form (6-Clicks) is a prediction tool, validated for other orthopedic procedures, to assess a patient's ability to mobilize after surgery.

PURPOSE

To assess the thresholds of AM-PAC scores that determine non-home discharge disposition in patients who have undergone ASD surgery.

STUDY DESIGN

Retrospective review

PATIENT SAMPLE

Ninety consecutive ASD patients with ≥5 levels fused who underwent surgery from 2015 to 2018, with postoperative AM-PAC scores measured before discharge, were included.

OUTCOME MEASURES

Non-home discharge disposition

METHODS

Patients with routine home discharge were compared to those with non-home discharge. Bivariate analysis was first conducted to compare these groups by preoperative demographics, comorbidities, radiographic alignment, surgical characteristics, HRQOLs, and AM-PAC measurements. Threshold linear regression with Bayesian information criteria was utilized to identify the optimal cutoffs for AM-PAC scores associated with increased likelihood of non-home discharge. Finally, multivariable analysis controlling for age, sex, comorbidities, levels fused, perioperative complication, and home support was conducted to assess each threshold.

RESULTS

Thirty-six (40%) of 90 patients analyzed had non-home discharge. On bivariate analysis, first AM-PAC score (13.5 vs. 17), last AM-PAC score (17 vs. 20), and AM-PAC change per day (+.387 vs. +1) were all significantly associated with non-home discharge. Threshold regression identified that cutoffs of ≤15 for first AM-PAC score, <17 for last AM-PAC score, and <+0.625 for daily AM-PAC change were associated with non-home discharge. On multivariable analysis, first AM-PAC score ≤15 (odds ratio [OR] 11.28; confidence interval [CI] 2.96-42.99; p<.001), last AM-PAC score <17 (OR 33.57; CI 5.85-192.82; p<.001), and AM-PAC change per day <+0.625 (OR 6.24; CI 2.01-19.43; p<.001) were all associated with increased odds of non-home discharge.

CONCLUSIONS

First AM-PAC score of 15 or less can help predict non-home discharge. A goal of daily AM-PAC increases of 0.625 points toward a final AM-PAC score of 17 can aid in achieving home discharge. The early AM-PAC mobility threshold of ≤15 may help prepare for non-home discharge, while AM-PAC daily changes per day <0.625 and final AM-PAC <17 may provide goals for mobility improvement during the early postoperative period in order to prevent non-home discharge.

中文翻译：

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AM-PAC 活动评分预测成人脊柱畸形手术后非回家出院

背景语境

成人脊柱畸形 (ASD) 手术需要较长的恢复期，并且通常需要非常规出院。急性期后护理 (AM-PAC) 基本移动住院患者短表（6 次点击）的活动测量是一种预测工具，已针对其他骨科手术进行验证，用于评估患者在手术后的活动能力。

目的

评估 AM-PAC 评分的阈值，以确定接受 ASD 手术的患者的非家庭出院处置。

学习规划

回顾性审查

患者样本

纳入 2015 年至 2018 年接受手术且术后 AM-PAC 评分在出院前测量的连续 90 例≥5 节段融合的 ASD 患者。

结果测量

非居家出院处置

方法

将常规出院患者与非出院患者进行比较。首先进行双变量分析，通过术前人口统计学、合并症、影像学排列、手术特征、HRQOL 和 AM-PAC 测量来比较这些组。使用贝叶斯信息标准的阈值线性回归来确定与非家庭出院可能性增加相关的 AM-PAC 分数的最佳截止点。最后，进行控制年龄、性别、合并症、融合水平、围手术期并发症和家庭支持的多变量分析来评估每个阈值。

结果

所分析的 90 名患者中有 36 名 (40%) 出院。在双变量分析中，第一个 AM-PAC 评分（13.5 对 17）、最后一个 AM-PAC 评分（17 对 20）和每天的 AM-PAC 变化（+.387 对 +1）都与非-家庭出院。阈值回归确定，第一次 AM-PAC 评分≤15、最后一次 AM-PAC 评分 <17 和每日 AM-PAC 变化 <+0.625 的截止值与非家庭出院相关。在多变量分析中，首次 AM-PAC 评分≤15（比值比 [OR] 11.28；置信区间 [CI] 2.96-42.99；p<.001），最后一次 AM-PAC 评分 <17（OR 33.57；CI 5.85-192.82； p<.001) 和每天 AM-PAC 变化 <+0.625（OR 6.24；CI 2.01-19.43；p<.001）都与非家庭出院几率增加有关。

结论

第一次 AM-PAC 得分为 15 或更低可以帮助预测非家庭出院。每天 AM-PAC 增加 0.625 分以达到 17 分的最终 AM-PAC 分数的目标可以帮助实现出院。≤15 的早期 AM-PAC 活动性阈值可能有助于为非家庭出院做准备，而 AM-PAC 每日变化 <0.625 和最终 AM-PAC <17 可能为术后早期的活动性改善提供目标，以便防止非居家放电。