Song Junho, Katz Austen D, Perfetti Dean, Job Alan, Morris Matthew, Goldstein Jeffrey, Virk Sohrab, Silber Jeff, Essig David
Department of Orthopedic Surgery, North Shore University Hospital-Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra University, New Hyde Park, NY.
Clin Spine Surg. 2022 Feb 1;35(1):24-30. doi: 10.1097/BSD.0000000000001174.
This was a retrospective cohort study.
The objective of this study was to compare 30-day postdischarge morbidity for 3-or-more level (multilevel) posterior lumbar fusion in patients who were discharged to home versus rehabilitation.
Spine surgery has been increasingly performed in the elderly population, with many of these patients being discharged to rehabilitation and skilled nursing facilities. However, research evaluating the safety of nonhome discharge following spine surgery is limited.
Patients who underwent multilevel posterior lumbar fusion from 2005 to 2018 were identified using the National Surgical Quality Improvement Program (NSQIP) database. Regression was utilized to compare primary outcomes between discharge disposition and to evaluate for predictors thereof.
We identified 5276 patients. Unadjusted analysis revealed that patients who were discharged to rehabilitation had greater postdischarge morbidity (5.6% vs. 2.6%). After adjusting for baseline differences, discharge to rehabilitation no longer predicted postdischarge morbidity [odds ratio (OR)=1.409, confidence interval: 0.918-2.161, P=0.117]. Multivariate analysis also revealed that age (P=0.026, OR=1.023), disseminated cancer (P=0.037, OR=6.699), and readmission (P<0.001, OR=28.889) independently predicted postdischarge morbidity.
Thirty days morbidity was statistically similar between patients who were discharged to home and rehabilitation. With appropriate patient selection, discharge to rehabilitation can potentially minimize 30-day postdischarge morbidity for more medically frail patients undergoing multilevel posterior lumbar fusion. These results are particularly important given an aging population, with a great portion of elderly patients who may benefit from postacute care facility discharge following spine surgery.
这是一项回顾性队列研究。
本研究的目的是比较出院回家与出院至康复机构的患者接受三节段或更多节段（多节段）后路腰椎融合术后30天的出院后发病率。
脊柱手术在老年人群中越来越普遍，许多此类患者出院后前往康复机构和专业护理机构。然而，评估脊柱手术后非回家出院安全性的研究有限。
利用国家外科质量改进计划（NSQIP）数据库识别2005年至2018年接受多节段后路腰椎融合术的患者。采用回归分析比较出院处置之间的主要结局，并评估其预测因素。
我们识别出5276例患者。未经调整的分析显示，出院至康复机构的患者出院后发病率更高（5.6%对2.6%）。在对基线差异进行调整后，出院至康复机构不再是出院后发病率的预测因素[比值比（OR）=1.409，置信区间：0.918 - 2.161，P = 0.117]。多变量分析还显示，年龄（P = 0.026，OR = 1.023）、播散性癌症（P = 0.037，OR = 6.699）和再次入院（P < 0.001，OR = 28.889）独立预测出院后发病率。
出院回家和出院至康复机构的患者30天发病率在统计学上相似。通过适当的患者选择，对于接受多节段后路腰椎融合术的身体较为虚弱的患者，出院至康复机构有可能将出院后30天发病率降至最低。鉴于人口老龄化，很大一部分老年患者可能从脊柱手术后的急性后期护理机构出院中受益，这些结果尤为重要。
