Department of Neurosurgery, Johns Hopkins Hospital, Meyer 5-185, 600 N Wolfe St, Baltimore, Baltimore, MD 21287, USA.
Center for Spine Health, Cleveland Clinic, Cleveland, OH, USA.
Spine J. 2020 Jul;20(7):1154-1158. doi: 10.1016/j.spinee.2020.02.022. Epub 2020 Mar 13.
Following spine surgery, delays in referral to rehabilitation facilities leads to increased length of hospital stay (LOS), increases costs, more risk of hospital acquired complications, and decreased patient satisfaction.
We sought to create a prediction calculator to determine the expected LOS after spine surgery and identify patients most likely to need postoperative nonhome discharge. The goal would be to facilitate earlier referral to rehabilitation and thereby ultimately shorten LOS, reduce costs, and improve patient satisfaction.
Retrospective.
We retrospectively reviewed all adult patients who underwent spine surgery for all indications between January and June 2018.
Length of stay and discharge disposition.
Demographic variables, insurance status, baseline comorbidities, narcotic use, operative characteristics, as well as postoperative length of stay and discharge disposition data were collected. Univariable and multivariable analyses were performed to identify independent predictors of LOS and discharge disposition.
Two hundred fifty-seven patients were included. Mean age was 59 years, 46% were females, and 52% had private insurance vs 7% with Medicaid and 41% with Medicare. The most commonly performed procedure was lumbar fusion (31.9%). Mean LOS after surgery was 4.8 days and 18% had prolonged LOS >7 days. Age, insurance type, marriage status, and surgical procedure were significantly associated with LOS and discharge disposition. The final model had an area under the curve of 89% with good discrimination. A web based calculator was developed: https://jhuspine1.shinyapps.io/RehabLOS/ CONCLUSIONS: This study established a novel pilot calculator to identify those patients most likely to be discharged to rehabilitation facilities and to predict LOS after spine surgery. Our calculator had a high predictive accuracy of 89% compared to others in the literature. With validation this tool may ultimately facilitate streamlining of the postoperative period to shorten LOS, optimize resource utilization, and improve patient care.
脊柱手术后，向康复机构转介的延迟会导致住院时间延长（LOS）增加，增加成本，增加医院获得性并发症的风险，并降低患者满意度。
我们旨在创建一个预测计算器，以确定脊柱手术后的预期 LOS，并确定最有可能需要术后非家庭出院的患者。目标是促进更早地向康复转介，从而最终缩短 LOS，降低成本，并提高患者满意度。
回顾性。
我们回顾性分析了 2018 年 1 月至 6 月期间所有因各种原因接受脊柱手术的成年患者。
住院时间和出院去向。
收集人口统计学变量、保险状况、基线合并症、阿片类药物使用、手术特征以及术后住院时间和出院去向数据。进行单变量和多变量分析以确定 LOS 和出院去向的独立预测因素。
共纳入 257 例患者。平均年龄为 59 岁，46%为女性，52%有私人保险，7%有医疗补助，41%有医疗保险。最常进行的手术是腰椎融合术（31.9%）。手术后的平均 LOS 为 4.8 天，18%的患者 LOS 延长>7 天。年龄、保险类型、婚姻状况和手术程序与 LOS 和出院去向显著相关。最终模型的 AUC 为 89%，具有良好的判别能力。开发了一个基于网络的计算器：https://jhuspine1.shinyapps.io/RehabLOS/
本研究建立了一种新的试点计算器，用于识别最有可能被转介到康复机构的患者，并预测脊柱手术后的 LOS。与文献中的其他计算器相比，我们的计算器具有 89%的高预测准确性。经过验证，该工具最终可能会简化术后流程，缩短 LOS，优化资源利用，并改善患者护理。
