Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
World Neurosurg. 2019 May;125:e958-e965. doi: 10.1016/j.wneu.2019.01.214. Epub 2019 Feb 11.
The purpose of this study was to identify predictors for postacute care facility discharge for patients undergoing posterior cervical decompression and fusion (PCDF) and to determine if discharge placement impacts postdischarge outcomes.
Patients undergoing PCDF from 2012 to 2015 were queried from the NSQIP database (n = 8743) and separated by discharge placement. Outcomes included nonhome discharge, unplanned 30-day readmission, and adverse events (AEs), both before and after discharge. Demographics and comorbidities were analyzed using bivariate analysis. Multivariate logistic regression was used to identify predictors for nonhome discharge, readmission, and severe AE after discharge.
Patients with nonhome discharges were significantly older (67.4 vs. 58.6 years; P < 0.001), sicker (82% vs. 54% American Society of Anesthesiologists >2; P < 0.001), and more functionally dependent (16% vs. 3.4%; P < 0.001), with a greater comorbidity burden. Patients with PCDF had an increased likelihood of nonhome discharge if they had a dependent functional status (odds ratio [OR], 2.99; 95% confidence interval [CI], 2.33-3.82; P < 0.001), diabetes (OR, 1.32; 95% CI, 1.13-1.55; P = 0.0007), and an American Society of Anesthesiologists >2 (OR, 1.75; 95% CI, 1.5-2.05; P < 0.001), as well as if they were older (OR, 1.06; 95% CI, 1.05-1.06; P < 0.001) and female (OR, 1.31; 95% CI, 1.14-1.5; P = 0.0002). Patients with PCDF with nonhome discharges had an increased likelihood of having a severe postdischarge AE (OR, 1.71; 95% CI, 1.26-2.33; P = 0.0006) and an unplanned readmission (OR, 1.45; 95% CI, 1.15-1.82; P = 0.002).
Results of this cross-sectional study suggest that patients with PCDF discharged to a postacute care facility have a higher likelihood of having a severe AE after discharge as well as a higher likelihood of being readmitted.
本研究旨在确定接受颈椎后路减压融合术（PCDF）患者转入急性后期护理机构的预测因素，并确定出院地点是否会影响出院后的结果。
从 NSQIP 数据库（n=8743）中查询 2012 年至 2015 年接受 PCDF 的患者，并按出院地点进行分类。出院后的结果包括非家庭出院、30 天内计划外再入院和不良事件（AE）。使用双变量分析来分析人口统计学和合并症。使用多变量逻辑回归来确定非家庭出院、再入院和出院后严重 AE 的预测因素。
非家庭出院患者的年龄明显较大（67.4 岁 vs. 58.6 岁；P < 0.001），病情较重（82% vs. 54%美国麻醉医师协会> 2；P < 0.001），功能依赖性更强（16% vs. 3.4%；P < 0.001），合并症负担更重。如果患者的功能状态依赖（比值比[OR]，2.99；95%置信区间[CI]，2.33-3.82；P < 0.001）、患有糖尿病（OR，1.32；95%CI，1.13-1.55；P=0.0007）和美国麻醉医师协会> 2（OR，1.75；95%CI，1.5-2.05；P < 0.001），或年龄较大（OR，1.06；95%CI，1.05-1.06；P < 0.001）和女性（OR，1.31；95%CI，1.14-1.5；P=0.0002），则 PCDF 患者更有可能非家庭出院。PCDF 非家庭出院患者发生严重出院后 AE（OR，1.71；95%CI，1.26-2.33；P=0.0006）和计划外再入院（OR，1.45；95%CI，1.15-1.82；P=0.002）的可能性更高。
本横断面研究结果表明，转入急性后期护理机构的 PCDF 患者出院后发生严重 AE 的可能性更高，再入院的可能性也更高。
