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  • Home vs Rehab: Factors That Influence Disposition After MIS Adult Spinal Deformity Surgery?

    Final Number:

    Robert Eastlack MD; Justin Ledesma MD; Stacie Nguyen BS, MPH; Khoi Duc Than MD; Paul Park MD; Praveen V. Mummaneni MD; Dean Chou MD; Adam S. Kanter MD; Neel Anand MD; Pierce D. Nunley MD; Frank La Marca MD; Richard G. Fessler MD PhD; Juan S. Uribe MD; Gregory M Mundis MD; International Spine Study Group

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting

    Introduction: MIS correction for ASD may reduce the need the need for postoperative skilled nursing (SNF) or rehabilitation facility placement following surgery. The likelihood of requiring placement in a facility, rather than home disposition, may be influenced by a variety of factors. Additionally, the association of discharge location on outcomes and complication rates has not been elucidated in these patients. In this study, we aimed to define factors predicting disposition to SNF/rehab, and the rates of complications occurring in patients sent home vs. a facility.

    Methods: Inclusion criteria: >18 yrs old, MIS as part of index surgery, location of discharge, and at least one of the following: PT>20, SVA>5cm, PI-LL>10, or lumbar scoliosis>20. Patients with 2 yr follow-up were included. Preoperative demographic and radiographic data, postop (<30 day) complications and HRQL were analyzed.

    Results: 182 patients met inclusion criteria. 113 were discharged home (HOM) vs 69 to SNF/rehab (REH). Older patients (>50) were more likely to go to REH (p=0.043). Those >70 yrs were 6 times more likely to go to REH. No association was identified among radiographic parameters except preop pelvic tilt (OR = 1.11 to SNF/Rehab, p=0.009). Staged cases were more likely to d/c to REH (OR 3.24; CI:1.11, 9.46; p=0.032) otherwise there was no difference for levels treated, OR time, EBL, osteotomy or length of stay. Patients requiring REH had more complications (58% v 39.8%, p=0.017) including Major (19.5 v 42%; p=0.001), perioperative (14.2 v 31.9%; p=0,004) and infections (3.5 v 13%; p=0.016). REH patients had higher revision rates (19.5% v 33%; p=0.035). (Table 1) HRQOL measures were similar regardless of disposition.

    Conclusions: Older patients and those undergoing staged MIS deformity correction, have a higher likelihood of postoperative disposition to rehab/SNF. Complications occurred more commonly in those patients requiring SNF/rehab after hospitalization.

    Patient Care: Understanding the different preoperative characteristics, and surgical factor that many influence discharge disposition can assist surgeons to better prepare patients postoperatively.

    Learning Objectives: By the conclusion of this session, participants should be able to 1) Describe the different patient populations that are discharged at different dispositions. 2) Discuss what preoperative and surgical factors that can affect discharge dispositions. 3) Identify preoperative and surgical factors that may increase likelihood of not being discharged home after ASD surgery.


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