Predictors of home discharge after scheduled surgery for degenerative cervical myelopathy

Lior M Elkaim; Greg McIntosh; Nicolas Dea; Rodrigo Navarro-Ramirez; W Bradley Jacobs; David W Cadotte; Supriya Singh; Sean D Christie; Aaron Robichaud; Philippe Phan; Jérôme Paquet; Andrew Nataraj; Hamilton Hall; Christopher S Bailey; Y Raja Rampersaud; Kenneth Thomas; Neil Manson; Charles Fisher; Michael H Weber

doi:10.3171/2022.2.SPINE2277

Predictors of home discharge after scheduled surgery for degenerative cervical myelopathy

J Neurosurg Spine. 2022 Apr 15:1-6. doi: 10.3171/2022.2.SPINE2277. Online ahead of print.

Authors

Lior M Elkaim^{1

2}, Greg McIntosh³, Nicolas Dea⁴, Rodrigo Navarro-Ramirez¹, W Bradley Jacobs⁵, David W Cadotte⁵, Supriya Singh⁶, Sean D Christie⁷, Aaron Robichaud⁸, Philippe Phan⁹, Jérôme Paquet¹⁰, Andrew Nataraj¹¹, Hamilton Hall¹², Christopher S Bailey⁶, Y Raja Rampersaud¹³, Kenneth Thomas⁵, Neil Manson¹⁴, Charles Fisher⁴, Michael H Weber¹

Affiliations

¹ 1Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec.
² 14Department of Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada.
³ 2Canadian Spine Outcomes and Research Network, Markdale, Ontario.
⁴ 3Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedics Surgery, University of British Columbia, Vancouver, British Columbia.
⁵ 4University of Calgary, Calgary, Alberta.
⁶ 5London Health Science Centre, Western University, London, Ontario.
⁷ 6Department of Surgery, Dalhousie University, Halifax, Nova Scotia.
⁸ 7Canada East Spine Centre, Division of Neurosurgery, Zone 2, Horizon Health Network, Saint John, New Brunswick.
⁹ 8The Ottawa Hospital, Ottawa, Ontario.
¹⁰ 9Centre de Recherche CHU de Quebec, CHU de Quebec-Universite Laval, Quebec City, Quebec.
¹¹ 10Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Edmonton, Alberta.
¹² 11Department of Surgery, University of Toronto, Toronto, Ontario.
¹³ 12Divisions of Orthopaedic and Neurosurgery, University of Toronto, Toronto, Ontario.
¹⁴ 13Canada East Spine Centre, Saint John Orthopedics, Dalhousie Medicine New Brunswick, Saint John Campus, Saint John, New Brunswick; and.

PMID: 35426825
DOI: 10.3171/2022.2.SPINE2277

Abstract

Objective: Degenerative cervical myelopathy (DCM) is an important public health issue. Surgery is the mainstay of treatment for moderate and severe DCM. Delayed discharge of patients after DCM surgery is associated with increased healthcare costs. There is a paucity of data regarding predictive factors for discharge destination after scheduled surgery for patients with DCM. The purpose of this study was to identify factors predictive of home versus nonhome discharge after DCM surgery.

Methods: Patients undergoing scheduled DCM surgery who had been enrolled in a prospective DCM substudy of the Canadian Spine Outcomes and Research Network registry between January 2015 and October 2020 were included in this retrospective analysis. Patient data were evaluated to identify potential factors predictive of home discharge after surgery. Logistic regression was used to identify independent factors predictive of home discharge. A multivariable model was then used as a final model.

Results: Overall, 639 patients were included in the initial analysis, 543 (85%) of whom were discharged home. The mean age of the entire cohort was 60 years (SD 11.8 years), with a BMI of 28.9 (SD 5.7). Overall, 61.7% of the patients were female. The mean length of stay was 2.72 days (SD 1.7 days). The final internally validated bootstrapped multivariable model revealed that younger age, higher 9-Item Patient Health Questionnaire score, lower Neck Disability Index scores, fewer operated levels, mJOA scores indicating mild disease, anterior cervical discectomy and fusion procedure, and no perioperative adverse effects were predictive of home discharge.

Conclusions: Younger age, less neck-related disability, fewer operated levels, more significant depression, less severe myelopathy, anterior cervical discectomy and fusion procedure, and no perioperative adverse effects are predictive of home discharge after surgery for DCM. These factors can help to guide clinical decision-making and optimize postoperative care pathways.

Keywords: DCM; cervical; degenerative; myelopathy; surgery.