Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA.
Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA.
Clin Neurol Neurosurg. 2021 Oct;209:106902. doi: 10.1016/j.clineuro.2021.106902. Epub 2021 Aug 21.
In various spinal surgeries, non-routine discharges have been associated with inferior outcomes. However, there exists a paucity of data regarding the relationship between non-routine discharge and quality of care among patients with spondylolisthesis. The aim of this study was to identify independent predictors for non-routine discharge following spinal decompression and fusion for lumbar spondylolisthesis.
A retrospective cohort study was performed using the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database from 2010 through 2016. Adult patients (≥18 years old) who underwent spinal decompression and fusion for lumbar spondylolisthesis were identified using ICD-9-CM diagnosis and CPT procedural coding systems. The study population was divided into two cohorts based on discharge disposition: routine (RD) and non-routine discharge (NRD). Patient demographics, comorbidities, adverse events, LOS, reoperation, and readmission were assessed. A multivariate logistic regression model was used to identify the independent predictors of non-home discharge and 30-day unplanned readmission.
A total of 5252 patients were identified, of which 4316 (82.2%) had a RD and 936 (18.8%) had a NRD. The NRD cohort tended to be older (p < 0.001) and have a higher BMI (p < 0.001). Patients who experienced a NRD had a longer LOS (NRD: 4.7 ± 3.7 days vs RD: 3.1 ± 2.0 days, p < 0.001), a higher proportion of adverse events (p < 0.001), higher rates of reoperation (p = 0.005) and unplanned 30-day readmission rates (p < 0.001). On multivariate regression analysis, age [OR: 1.08, 95% CI (1.06-1.10), p < 0.001], female sex [OR: 2.01, 95% (1.51-2.69), p < 0.001], non-Hispanic Black race/ethnicity [OR: 2.10, 95% CI (1.36-3.24), p = 0.001], BMI [OR: 1.03, 95% CI (1.01-1.05), p = 0.007], dependent functional status [OR: 3.33, 95% CI (1.59 - 6.99), p = 0.001], malnourishment [OR: 2.14, 95% CI (1.27-3.62), p = 0.005], and LOS [OR: 1.26, 95% CI (1.18-1.33), p < 0.001] were all independent predictors for NRD. However, NRD did not independently predict an unplanned 30-day readmission on multivariate analysis.
In our study we found that on univariate analysis NRD was associated with increased adverse events, length of stay and 30-day unplanned readmission. When controlling for patient- and hospital-related factors, we found that female sex, non-Hispanic Black race, BMI, dependent functional status, malnourishment and longer LOS were independently associated with NRD. However, NRD did not independently predict an unplanned 30-day readmission.
在各种脊柱手术中，非常规出院与较差的结果相关。然而，关于脊柱滑脱患者非常规出院与护理质量之间的关系，数据仍然匮乏。本研究旨在确定接受腰椎滑脱减压融合术患者非常规出院的独立预测因素。
使用美国外科医师学院（ACS）国家手术质量改进计划（NSQIP）数据库进行回顾性队列研究，时间为 2010 年至 2016 年。使用 ICD-9-CM 诊断和 CPT 手术编码系统确定接受腰椎滑脱减压融合术的成年患者（≥18 岁）。根据出院情况将研究人群分为常规出院（RD）和非常规出院（NRD）两组。评估患者的人口统计学、合并症、不良事件、住院时间（LOS）、再次手术和再入院情况。使用多变量逻辑回归模型确定非家庭出院和 30 天计划外再入院的独立预测因素。
共确定了 5252 例患者，其中 4316 例（82.2%）为 RD，936 例（18.8%）为 NRD。NRD 组患者年龄较大（p<0.001）且 BMI 较高（p<0.001）。NRD 组患者 LOS 较长（NRD：4.7±3.7 天 vs RD：3.1±2.0 天，p<0.001），不良事件比例较高（p<0.001），再次手术率较高（p=0.005）和 30 天计划外再入院率较高（p<0.001）。多变量回归分析显示，年龄[OR：1.08，95%CI（1.06-1.10），p<0.001]、女性[OR：2.01，95%CI（1.51-2.69），p<0.001]、非西班牙裔黑人种族/民族[OR：2.10，95%CI（1.36-3.24），p=0.001]、BMI[OR：1.03，95%CI（1.01-1.05），p=0.007]、依赖性功能状态[OR：3.33，95%CI（1.59-6.99），p=0.001]、营养不良[OR：2.14，95%CI（1.27-3.62），p=0.005]和 LOS[OR：1.26，95%CI（1.18-1.33），p<0.001]是 NRD 的独立预测因素。然而，NRD 与 30 天计划外再入院无独立相关性。
在本研究中，我们发现非常规出院与不良事件、住院时间和 30 天计划外再入院增加相关。在控制患者和医院相关因素后，我们发现女性、非西班牙裔黑人种族、BMI、依赖性功能状态、营养不良和较长的 LOS 与 NRD 独立相关。然而，NRD 与 30 天计划外再入院无独立相关性。
