Sastry Rahul A, Hagan Matthew J, Feler Joshua, Shaaya Elias A, Sullivan Patricia Z, Abinader Jose Fernandez, Camara Joaquin Q, Niu Tianyi, Fridley Jared S, Oyelese Adetokunbo A, Sampath Prakash, Telfeian Albert E, Gokaslan Ziya L, Toms Steven A, Weil Robert J
Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA.
Southcoast Health Brain & Spine, Dartmouth, Massachusetts, USA.
Neurosurgery. 2022 Jun 1;90(6):734-742. doi: 10.1227/neu.0000000000001893. Epub 2022 Apr 7.
Encouraging early time of discharge (TOD) for medical inpatients is commonplace and may potentially improve patient throughput. It is unclear, however, whether early TOD after elective spine surgery achieves this goal without a consequent increase in re-presentations to the hospital.
To evaluate whether early TOD results in increased rates of hospital readmission or return to the emergency department after elective anterior cervical spine surgery.
We analyzed 686 patients who underwent elective uncomplicated anterior cervical spine surgery at a single institution. Logistic regression was used to evaluate the relationship between sociodemographic, procedural, and discharge characteristics, and the outcomes of readmission or return to the emergency department and TOD.
In multiple logistic regression, TOD was not associated with increased risk of readmission or return to the emergency department within 30 days of surgery. Weekend discharge (odds ratio [OR] 0.33, 95% CI 0.21-0.53), physical therapy evaluation (OR 0.44, 95% CI 0.28-0.71), and occupational therapy evaluation (OR 0.32, 95% CI 0.17-0.63) were all significantly associated with decreased odds of discharge before noon. Disadvantaged status, as measured by area of deprivation index, was associated with increased odds of readmission or re-presentation (OR 1.86, 95% CI 0.95-3.66), although this result did not achieve statistical significance.
There does not appear to be an association between readmission or return to the emergency department and early TOD after elective spine surgery. Overuse of inpatient physical and occupational therapy consultations may contribute to decreased patient throughput in surgical admissions.
鼓励内科住院患者提前出院（TOD）很常见，且可能会提高患者周转率。然而，目前尚不清楚选择性脊柱手术后的早期TOD能否实现这一目标，同时又不会导致再次入院率增加。
评估选择性颈椎前路手术后早期TOD是否会导致医院再入院率或返回急诊科的比率增加。
我们分析了在单一机构接受选择性非复杂性颈椎前路手术的686例患者。采用逻辑回归分析来评估社会人口统计学、手术和出院特征与再入院或返回急诊科以及TOD结果之间的关系。
在多元逻辑回归中，TOD与术后30天内再入院或返回急诊科的风险增加无关。周末出院（优势比[OR]0.33，95%置信区间0.21-0.53）、物理治疗评估（OR 0.44，95%置信区间0.28-0.71）和职业治疗评估（OR 0.32，95%置信区间0.17-0.63）均与中午前出院几率降低显著相关。以贫困指数区域衡量的弱势地位与再入院或再次就诊几率增加相关（OR 1.86，95%置信区间0.95-3.66），尽管这一结果未达到统计学显著性。
选择性脊柱手术后再入院或返回急诊科与早期TOD之间似乎没有关联。住院患者过度使用物理和职业治疗会诊可能会导致手术入院患者周转率降低。
