Katz Austen D, Song Junho, Ngan Alex, Job Alan, Morris Matthew, Perfetti Dean, 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 May 1;35(4):129-136. doi: 10.1097/BSD.0000000000001319. Epub 2022 Apr 6.
Retrospective cohort study.
The aim was to compare 30-day readmission and postdischarge morbidity for posterior cervical decompression and fusion (PCDF) in patients who were discharged to home versus rehabilitation.
An increasing number of patients are being discharged to postacute inpatient care facilities following spine surgery. However, little research has been performed to evaluate the effect of this trend on short-term outcomes.
Patients who underwent PCDF from 2011 to 2018 were identified using the National Surgical Quality Improvements Program (NSQIP)-database. Regression was utilized to compare primary outcomes between home and rehabilitation groups and to control for predictors of outcomes.
We identified 8912 patients. Unadjusted analysis revealed that rehabilitation-discharge patients had greater readmission (10.4% vs. 8.0%, P=0.002) and postdischarge morbidity (7.1% vs. 4.0%, P<0.001) rates. After controlling for patient-related factors, rehabilitation-discharge independently predicted postdischarge morbidity (P<0.001, odds ratio=2.232). Readmission no longer differed between groups (P=0.071, odds ratio=1.311). Rates of discharge to rehabilitation increased from 23.5% in 2011 to 25.3% in 2018, while postdischarge morbidity rates remained stagnant.Patients discharged to rehabilitation were older (66.9 vs. 59.4 y); more likely to be African American (21.4% vs. 13.8%) and have diabetes (27.1% vs. 17.5%), steroid use (6.4% vs. 4.7%, P=0.002), and American Society of Anaesthesiologists (ASA)-class ≥3 (80.2% vs. 57.7%); less likely to be male (53.9% vs. 57.4%, P=0.004) and smokers (20.3% vs. 26.6%); and had greater operative time (198 vs. 170 min) and length of hospital stay (5.9 vs. 3.3 d) (P<0.001).
Despite controlling for significant factors, discharge to rehabilitation independently predicted a 2.2 times increased odds of postdischarge morbidity. Rates of discharge to rehabilitation increased overtime without an appreciable decrease in postdischarge morbidity, suggesting that greater resources are being utilized in the postacute care period without an obvious justification. Therefore, home-discharge should be prioritized after hospitalization for PCDF when feasible. These findings are notable in light of reform efforts aimed at reducing costs while improving quality of care.
回顾性队列研究。
旨在比较出院回家与出院后接受康复治疗的患者行颈椎后路减压融合术（PCDF）后的30天再入院率和出院后发病率。
脊柱手术后越来越多的患者被出院转至急性后期住院护理机构。然而，很少有研究评估这一趋势对短期结局的影响。
使用国家外科质量改进计划（NSQIP）数据库识别2011年至2018年接受PCDF的患者。采用回归分析比较回家组和康复组的主要结局，并控制结局的预测因素。
我们共识别出8912例患者。未经调整的分析显示，康复出院患者的再入院率（10.4%对8.0%，P = 0.002）和出院后发病率（7.1%对4.0%，P < 0.001）更高。在控制了患者相关因素后，康复出院独立预测出院后发病率（P < 0.001，比值比 = 2.232）。两组间再入院率不再有差异（P = 0.071，比值比 = 1.311）。康复出院率从2011年的23.5%增至2018年的25.3%，而出院后发病率保持稳定。出院后接受康复治疗的患者年龄更大（66.9岁对59.4岁）；更可能是非裔美国人（21.4%对13.8%）且患有糖尿病（27.1%对17.5%）、使用类固醇（6.4%对4.7%，P = 0.002）以及美国麻醉医师协会（ASA）分级≥3（80.2%对57.7%）；男性（53.9%对57.4%，P = 0.004）和吸烟者（20.3%对26.6%）的可能性更低；手术时间更长（198分钟对170分钟）且住院时间更长（5.9天对3.3天）（P < 0.001）。
尽管控制了显著因素，但出院后接受康复治疗仍独立预测出院后发病几率增加2.2倍。康复出院率随时间增加，而出院后发病率没有明显下降，这表明在急性后期护理期间使用了更多资源但缺乏明显合理依据。因此，可行的情况下，PCDF术后住院患者应优先考虑出院回家。鉴于旨在降低成本同时提高护理质量的改革努力，这些发现值得关注。
