Predictors of Admission to Post-Acute Rehabilitation Following Multi-Level Spinal Decompression and Fusion Surgery and Its Associated Outcomes

Drupad Annapureddy; Pooja Venkatesh; Faraaz Azam; Timothy Olivier; Bhaskar Thakur; Ellen Sloan; Sarah Wingfield; Carlos Bagley; Marielisa Lopez

doi:10.1016/j.wneu.2024.04.010

Predictors of Admission to Post-Acute Rehabilitation Following Multi-Level Spinal Decompression and Fusion Surgery and Its Associated Outcomes

World Neurosurg. 2024 Apr 8:S1878-8750(24)00572-2. doi: 10.1016/j.wneu.2024.04.010. Online ahead of print.

Authors

Drupad Annapureddy¹, Pooja Venkatesh², Faraaz Azam¹, Timothy Olivier³, Bhaskar Thakur⁴, Ellen Sloan³, Sarah Wingfield⁵, Carlos Bagley⁶, Marielisa Lopez³

Affiliations

¹ The University of Texas Southwestern Medical School, Dallas, Texas, USA.
² The University of Texas Southwestern Medical School, Dallas, Texas, USA. Electronic address: Pooja.Venkatesh@UTSouthwestern.edu.
³ Department of Physical Medicine & Rehabilitation, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.
⁴ Department of Physical Medicine & Rehabilitation, The University of Texas Southwestern Medical Center, Dallas, Texas, USA; Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA; Department of Family and Community Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.
⁵ Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.
⁶ Department of Neurological Surgery, Saint Luke's Neurological & Spine Surgery, Kansas City, Missouri, USA.

PMID: 38599376
DOI: 10.1016/j.wneu.2024.04.010

Abstract

Objective: To investigate predictive factors and outcomes in those admitted to post-acute rehabilitation (PAR) versus those that discharged home following multi-level spinal decompression and fusion surgery.

Methods: Retrospective case review study of adults that underwent multi-level spinal decompression and fusion surgery between 2016 and 2022 at an academic institution. Preoperative, perioperative, postoperative, and outcomes variables were compared between those discharged home versus PAR. Finally, multiple logistic regression was used to determine factors contributing to PAR admission.

Results: Of 241 total patients, 89 (37%) discharged home and 152 (63%) discharged to PAR. Among home discharge patients, 45.9% used an assistive device, while among PAR patients, 61.5% used 1 (P = 0.041). Mean pre-operative Oswestry Disability Index score was significantly lower in the home discharge group compared to the PAR discharge group (40.3 vs. 45.3 respectively, P = 0.044). Females were 2.43 times more likely to be discharged to PAR compared to males (95% CI: 1.06, 5.54, P = 0.04). Patients with a mood disorder had 2.81 times higher odds of being discharged to PAR compared to those without (95% CI: 1.20, 6.60, P = 0.02). Other variables evaluated were not statistically significant.

Conclusions: Female sex and presence of a mood disorder increase the likelihood to PAR discharge following multi-level spinal decompression surgery.

Keywords: Outcomes; Post–acute rehabilitation; Predictors of admission; Retrospective study; Spinal decompression; Spinal fusion; Spine surgery.