Objectives: Previous literature has studied overall post-operative outcomes following lumbar fusions. We examined the rates and risk factors for adverse outcomes in patients who are being discharged home.
Patients and methods: The 2012-2016 ACS-NSQIP database was used to query for patients undergoing 1- to 2-level posterior lumbar fusions (PLFs) for degenerative spinal pathology. Patients discharged to a destination other than home were removed from the database.
Results: Out of a total of 19,179 home-discharge patients, 546 (2.8%) experienced any adverse event (AAE), 276 experienced a severe adverse event (SAE) and 321 (1.7%) experienced a minor adverse event (MAE). Overall re-admission and re-operation rate in home-discharged patients was 4.4% and 2.5%. Multivariate analysis identified the following predictors for experiencing an AAE - Bleeding disorder (OR 2.25), BMI ≥ 35.0 vs. BMI < 25 (OR 1.96), chronic steroid use (OR 1.89), a LOS > 3 days (OR 1.53), insulin-dependent diabetes mellitus (OR 1.44), hypertension (OR 1.28) and female gender (OR 1.24). Patients with a pre-discharge complication (OR 2.12), bleeding disorders (OR 1.84), chronic steroid use (OR 1.55), age>75 (OR 1.49), age>65 (OR 1.26), history of severe COPD (OR 1.43), total operative time >210 min. (OR 1.26), ASA > II (OR 1.26) and undergoing a 2-level fusion (OR 1.21) were likely to be re-admitted from home.
Conclusions: Providers should utilize the data to risk-stratify and better understand the need of provision of supplemental health-care services, in home-discharged patients, and/or regular clinic follow-up to minimize the rate of adverse events and reduce costs in a bundled-payment environment.
Keywords: Adverse events; Bundled payments; Complications; Home discharge; NSQIP; Posterior lumbar fusions; Readmissions.
Copyright © 2019. Published by Elsevier B.V.