Risk Factors and Outcomes of Non-home Discharge in Patients Undergoing Posterior Lumbar Fusions

Introduction: For patients that fail conservative treatment, lumbar interbody fusions offer an effective surgical intervention to reduce pain, and disability. Characterizing risk profiles associated with non-home discharge has the potential to reduce healthcare costs and improve patient counseling. Thus, this study aimed to better understand risk factors and analyze outcomes of posterior lumbar fusion patients—including posterior and transforaminal approaches—prone to non-home discharge.

Methods: Patients were selected through Current Procedural Terminology (CPT) codes for posterior approaches to interbody fusion from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) from 2018 to 2020. Non-home discharge was defined as discharge to skilled care facilities and/or inpatient rehabilitation units. Chi-squared and multivariate logistic regressions were used, with significance at P< 0.05.

Results: This study included 21,061 patients, with 3,030 (14.4%) discharged to non-home facilities. Multivariate regression revealed age (OR: 1.06, P< 0.001), increased BMI (OR: 1.03, P< 0.001), female sex (OR: 1.42, P< 0.001), Hispanic ethnicity (OR: 1.33, P< 0.001), >10% weight loss in the last 6 months (OR: 2.68, P< 0.001), length of hospital stay (OR: 4.14, P< 0.001), American Society of Anesthesiologists grade (OR: 1.70, P< 0.001), 5-item modified frailty index (OR: 1.21, P< 0.001), minor and major predischarge complications (OR: 2.52, P< 0.001; OR: 2.19, P< 0.001, respectively) as independent risk factors for non-home discharge. Discharge to a non-home facility was associated with a higher likelihood of wound, cerebral, cardiac, pulmonary, and renal complications (all P< 0.001). While mortality rates were comparable between groups (P=0.11), the non-home discharge cohort had significantly higher rates of 30-day readmissions (P < 0.001) and reoperations (P < 0.001).

Conclusion : With a growing focus on reducing healthcare costs and expediting recovery, surgeons can utilize a better understanding of risk factors for non-home discharge to guide pre-operative patient counseling and management.