Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline St, JHOC 5241, Baltimore, MD 21287, USA.
Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline St, JHOC 5241, Baltimore, MD 21287, USA.
Spine J. 2022 Nov;22(11):1884-1892. doi: 10.1016/j.spinee.2022.07.093. Epub 2022 Jul 20.
Adult spinal deformity (ASD) surgery requires an extended recovery period and often non-routine discharge. The Activity Measure for Post-Acute Care (AM-PAC) Basic Mobility Inpatient Short Form (6-Clicks) is a prediction tool, validated for other orthopedic procedures, to assess a patient's ability to mobilize after surgery.
To assess the thresholds of AM-PAC scores that determine non-home discharge disposition in patients who have undergone ASD surgery.
Retrospective review PATIENT SAMPLE: Ninety consecutive ASD patients with ≥5 levels fused who underwent surgery from 2015 to 2018, with postoperative AM-PAC scores measured before discharge, were included.
Non-home discharge disposition METHODS: Patients with routine home discharge were compared to those with non-home discharge. Bivariate analysis was first conducted to compare these groups by preoperative demographics, comorbidities, radiographic alignment, surgical characteristics, HRQOLs, and AM-PAC measurements. Threshold linear regression with Bayesian information criteria was utilized to identify the optimal cutoffs for AM-PAC scores associated with increased likelihood of non-home discharge. Finally, multivariable analysis controlling for age, sex, comorbidities, levels fused, perioperative complication, and home support was conducted to assess each threshold.
Thirty-six (40%) of 90 patients analyzed had non-home discharge. On bivariate analysis, first AM-PAC score (13.5 vs. 17), last AM-PAC score (17 vs. 20), and AM-PAC change per day (+.387 vs. +1) were all significantly associated with non-home discharge. Threshold regression identified that cutoffs of ≤15 for first AM-PAC score, <17 for last AM-PAC score, and <+0.625 for daily AM-PAC change were associated with non-home discharge. On multivariable analysis, first AM-PAC score ≤15 (odds ratio [OR] 11.28; confidence interval [CI] 2.96-42.99; p<.001), last AM-PAC score <17 (OR 33.57; CI 5.85-192.82; p<.001), and AM-PAC change per day <+0.625 (OR 6.24; CI 2.01-19.43; p<.001) were all associated with increased odds of non-home discharge.
First AM-PAC score of 15 or less can help predict non-home discharge. A goal of daily AM-PAC increases of 0.625 points toward a final AM-PAC score of 17 can aid in achieving home discharge. The early AM-PAC mobility threshold of ≤15 may help prepare for non-home discharge, while AM-PAC daily changes per day <0.625 and final AM-PAC <17 may provide goals for mobility improvement during the early postoperative period in order to prevent non-home discharge.
成人脊柱畸形（ASD）手术需要较长的恢复期，通常需要非常规出院。活动测量用于康复治疗后评估（AM-PAC）基本移动性住院短期表（6 次点击）是一种预测工具，已针对其他骨科手术进行了验证，用于评估患者手术后的移动能力。
评估 AM-PAC 评分阈值，以确定接受 ASD 手术的患者非居家出院的情况。
回顾性研究
90 例连续 ASD 患者，至少融合 5 个节段，2015 年至 2018 年接受手术，术后出院前测量 AM-PAC 评分，均纳入研究。
非居家出院处置方式。
比较常规居家出院与非居家出院患者。首先进行二元分析，比较两组患者的术前人口统计学、合并症、影像学排列、手术特征、HRQOL 和 AM-PAC 测量值。利用贝叶斯信息准则的线性回归阈值分析，确定与非居家出院可能性增加相关的 AM-PAC 评分的最佳截止值。最后，进行多变量分析，控制年龄、性别、合并症、融合节段数、围手术期并发症和家庭支持，评估每个截止值。
90 例患者中有 36 例（40%）分析为非居家出院。在二元分析中，首次 AM-PAC 评分（13.5 分与 17 分）、末次 AM-PAC 评分（17 分与 20 分）和 AM-PAC 每日变化（+0.387 与+1）均与非居家出院显著相关。阈值回归确定，首次 AM-PAC 评分≤15、末次 AM-PAC 评分<17 和 AM-PAC 每日变化<+0.625 与非居家出院相关。多变量分析显示，首次 AM-PAC 评分≤15（比值比 [OR] 11.28；置信区间 [CI] 2.96-42.99；p<.001）、末次 AM-PAC 评分<17（OR 33.57；CI 5.85-192.82；p<.001）和 AM-PAC 每日变化<+0.625（OR 6.24；CI 2.01-19.43；p<.001）与非居家出院的可能性增加相关。
首次 AM-PAC 评分≤15 有助于预测非居家出院。每日 AM-PAC 增加 0.625 分，最终 AM-PAC 评分达到 17 分，可有助于实现居家出院。早期 AM-PAC 移动性≤15 的阈值可能有助于为非居家出院做准备，而每日 AM-PAC 变化<0.625 和最终 AM-PAC<17 可能为术后早期改善移动能力提供目标，以防止非居家出院。
