Eastlack Robert K, Ledesma Justin B, Tran Stacie, Khalsa Amrit, Park Paul, Mummaneni Praveen V, Chou Dean, Kanter Adam S, Anand Neel, Nunley Pierce, La Marca Frank, Fessler Richard G, Uribe Juan S, Mundis Gregory M
Department of Orthopedic Surgery, Scripps Clinic, La Jolla, California, USA; Department of Orthopedic Surgery, San Diego Spine Foundation, San Diego, California, USA.
Department of Orthopedic Surgery, San Diego Spine Foundation, San Diego, California, USA.
World Neurosurg. 2018 Oct;118:e610-e615. doi: 10.1016/j.wneu.2018.06.249. Epub 2018 Jul 10.
Minimally invasive surgery (MIS) correction for adult spinal deformity (ASD) may reduce the need the need for postoperative skilled nursing facility (SNF) or inpatient rehabilitation (IR) placement following surgery. The likelihood of requiring placement in a facility rather than home disposition may be influenced by various factors. In addition, the associations between discharge location and outcomes and complication rates have not been elucidated in these patients. In this study, we aimed to define factors predicting disposition to an SNF/IR and to elucidate the rates of complications occurring in patients sent to home versus to a facility.
A retrospective review of a multicenter ASD database, which included patients who underwent surgery between 2009 and 2014. Inclusion criteria were age >18 years, MIS as part of index surgery, location of discharge, and at least 1 of the following: pelvic tilt >20°, sagittal vertical axis >5 cm, pelvic incidence-lumbar lordosis mismatch >10, or lumbar scoliosis >20°. Patients with a 2-year follow-up were included. Preoperative demographic and radiographic data, postoperative (<30 day) complications, and health-related quality of life were analyzed.
A total of 182 patients met our inclusion criteria, including 113 who were discharged to home and 69 who were discharged to an SNF/IR. Older patients (>50 years) were more likely to be discharged to an SNF/IR (P = 0.043). Those aged >70 years were 6-fold more likely to go to an SNF/IR. No association was identified between discharge to an SNF/IR and any radiographic parameters except preoperative pelvic tilt (odds ratio [OR], 1.11; P = 0.009). Staged cases were more likely to be discharged to an SNF/IR (OR, 3.24; 95% confidence interval, 1.11-9.46; P = 0.032); otherwise, there was no difference in levels treated, operating time, estimated blood loss, osteotomy, or length of hospital stay. Patients requiring discharge to an SNF/IR had a higher rate of complications (58% vs. 39.8%; P = 0.017), including major complications (19.5% vs. 42%; P = 0.001), perioperative complications (14.2% vs. 31.9%; P = 0.004) and infections (3.5% vs. 13%; P = 0.016). Patients discharged to an SNF/IR had a higher rate of revision (19.5% vs. 33%; P = 0.035). Health-related quality of life measures were similar regardless of disposition.
Older patients and those undergoing staged MIS deformity correction have a higher likelihood of postoperative disposition to an SNF/IR. Complications occurred more commonly in those patients requiring transfer to an SNF/IR after hospitalization.
成人脊柱畸形（ASD）的微创手术（MIS）矫正可能会减少术后对专业护理机构（SNF）或住院康复（IR）安置的需求。需要安置在机构而非在家中休养的可能性可能受多种因素影响。此外，这些患者出院地点与预后及并发症发生率之间的关联尚未阐明。在本研究中，我们旨在确定预测患者入住SNF/IR的因素，并阐明回家与入住机构的患者的并发症发生率。
对一个多中心ASD数据库进行回顾性分析，该数据库纳入了2009年至2014年间接受手术的患者。纳入标准为年龄>18岁、作为初次手术一部分的MIS、出院地点以及以下至少一项：骨盆倾斜>20°、矢状垂直轴>5 cm、骨盆入射角-腰椎前凸不匹配>10或腰椎侧弯>20°。纳入有2年随访的患者。分析术前人口统计学和影像学数据、术后（<30天）并发症以及健康相关生活质量。
共有182例患者符合我们的纳入标准，其中113例出院回家，69例出院至SNF/IR。年龄较大（>50岁）的患者更有可能出院至SNF/IR（P = 0.043）。70岁以上的患者前往SNF/IR的可能性高6倍。除术前骨盆倾斜外，未发现出院至SNF/IR与任何影像学参数之间存在关联（优势比[OR]，1.11；P = 0.009）。分期手术的病例更有可能出院至SNF/IR（OR，3.24；95%置信区间，1.11 - 9.46；P = 0.032）；否则，在治疗节段、手术时间、估计失血量、截骨术或住院时间方面没有差异。需要出院至SNF/IR的患者并发症发生率更高（58%对39.8%；P = 0.017），包括严重并发症（19.5%对42%；P = 0.001）、围手术期并发症（14.2%对31.9%；P = 0.004）和感染（3.5%对13%；P = 0.016）。出院至SNF/IR的患者翻修率更高（19.5%对33%；P = 0.035）。无论出院地点如何，健康相关生活质量指标相似。
年龄较大的患者以及接受分期MIS畸形矫正的患者术后入住SNF/IR的可能性更高。并发症在住院后需要转至SNF/IR的患者中更常见。
