Denver International Spine Center, Rocky Mountain Hospital for Children and Presbyterian St. Luke's Medical Center, Denver, CO.
Department of Neurosurgery, University of California San Francisco School of Medicine, San Francisco, CA.
Spine (Phila Pa 1976). 2024 May 1;49(9):E117-E127. doi: 10.1097/BRS.0000000000004825. Epub 2023 Sep 9.
Retrospective review of a prospective multicenter adult spinal deformity (ASD) study.
The aim of this study was to evaluate 30-day readmissions, 90-day return to surgery, postoperative complications, and patient-reported outcomes (PROs) for matched ASD patients receiving nonhome discharge (NON), including acute rehabilitation (REHAB), and skilled nursing facility (SNF), or home (HOME) discharge following ASD surgery.
Postoperative disposition following ASD surgery frequently involves nonhome discharge. Little data exists for longer term outcomes for ASD patients receiving nonhome discharge versus patients discharged to home.
Surgically treated ASD patients prospectively enrolled into a multicenter study were assessed for NON or HOME disposition following hospital discharge. NON was further divided into REHAB or SNF. Propensity score matching was used to match for patient age, frailty, spine deformity, levels fused, and osteotomies performed at surgery. Thirty-day hospital readmissions, 90-day return to surgery, postoperative complications, and 1-year and minimum 2-year postoperative PROs were evaluated.
A total of 241 of 374 patients were eligible for the study. NON patients were identified and matched to HOME patients. Following matching, 158 patients remained for evaluation; NON and HOME had similar preoperative age, frailty, spine deformity magnitude, surgery performed, and duration of hospital stay ( P >0.05). Thirty-day readmissions, 90-day return to surgery, and postoperative complications were similar for NON versus HOME and similar for REHAB (N=64) versus SNF (N=42) versus HOME ( P >0.05). At 1-year and minimum 2-year follow-up, HOME demonstrated similar to better PRO scores including Oswestry Disability Index, Short-Form 36v2 questionnaire Mental Component Score and Physical Component Score, and Scoliosis Research Society scores versus NON, REHAB, and SNF ( P <0.05).
Acute needs must be considered following ASD surgery, however, matched analysis comparing 30-day hospital readmissions, 90-day return to surgery, postoperative complications, and PROs demonstrated minimal benefit for NON, REHAB, or SNF versus HOME at 1- and 2-year follow-up, questioning the risk and cost/benefits of routine use of nonhome discharge.
Level III-prognostic.
前瞻性多中心成人脊柱畸形（ASD）研究的回顾性研究。
本研究旨在评估接受非家庭出院（NON）的 ASD 患者，包括急性康复（REHAB）、熟练护理设施（SNF）或家庭（HOME）出院后 30 天内再入院、90 天内返回手术、术后并发症和患者报告的结果（PROs），与接受 ASD 手术后 HOME 出院的患者进行匹配。
ASD 手术后的术后处置通常涉及非家庭出院。对于接受非家庭出院的 ASD 患者与出院回家的患者的长期结果，数据很少。
前瞻性入组多中心研究的接受手术治疗的 ASD 患者，评估出院后的 NON 或 HOME 处置。NON 进一步分为 REHAB 或 SNF。使用倾向评分匹配来匹配患者年龄、虚弱程度、脊柱畸形程度、融合的水平和手术中进行的截骨术。评估 30 天内的住院再入院、90 天内的再次手术、术后并发症以及 1 年和至少 2 年的术后 PROs。
共有 374 名患者中的 241 名符合研究条件。确定了 NON 患者并与 HOME 患者进行了匹配。匹配后，仍有 158 名患者接受评估；NON 和 HOME 的术前年龄、虚弱程度、脊柱畸形程度、手术类型和住院时间相似（P>0.05）。NON 与 HOME 之间以及 REHAB（N=64）与 SNF（N=42）与 HOME 之间的 30 天再入院、90 天再次手术和术后并发症相似（P>0.05）。在 1 年和至少 2 年的随访中，HOME 与 NON、REHAB 和 SNF 相比，PRO 评分相似或更好，包括 Oswestry 残疾指数、36v2 短表格问卷的精神成分评分和身体成分评分以及脊柱侧凸研究协会评分（P<0.05）。
ASD 手术后必须考虑急性需求，但在 1 年和 2 年的随访中，比较 30 天内医院再入院、90 天内再次手术、术后并发症和 PROs 的匹配分析表明，NON、REHAB 或 SNF 与 HOME 相比，获益最小，这对常规使用非家庭出院的风险和成本效益提出了质疑。
III 级-预后。
