Introduction: Anterior cervical discectomy and fusion (ACDF) is performed to treat a variety of cervical pathologies. The possibility of episode-based bundled payments for spine surgery necessitates analysis of factors predicting readmissions and postoperative complications. The objective of the present study was to analyze whether discharge destination is correlated with rates of readmission and post-discharge complications in patients undergoing ACDF.
Methods: Patients undergoing ACDF in the American College of Surgeons National Surgical Quality Improvement Program were queried via Current Procedural Terminology codes 63075, 22554, and 22551. Patients were grouped based on discharge destination, either to home/home-healthcare or to a facility. Those who expired before discharge were excluded. Relevant demographics, comorbidities, perioperative statistics, and pre- and post-discharge complications were compared. Multivariable logistic regression models for severe post-discharge complications and 30-day readmissions were created, with the exposure of non-home discharge.
Results: Patients discharged to non-home destinations were significantly older (63.96 vs 53.57 years, P<0.0001), sicker (77.89% of patients had ASA Class > 2 vs 39.57%, P<0.0001), more dependent (13.87% vs 1.09%, P<0.0001), and had significantly greater BMIs (9.38% of patients had BMI > 40 vs 7.51% , P=0.004) than patients discharged to home. Non-home discharged patients were more likely to suffer both a severe (14.44% vs 0.93%, P<0.0001) and minor (7.22% vs 0.24%, P<0.0001) pre-discharge complication and had longer mean lengths of stay (8.81 vs 1.76 days, P<0.0001). Following discharge, patients in the non-home discharge group had a higher mortality (1.25% vs 0.07%, P<0.0001) and were more likely to experience a severe complication (6.37% vs 1.34%, P<0.0001), minor complication (4.09% vs 0.74%, P<0.0001), and readmission (10.12% vs 3.06%, P<0.0001). Non-home discharge proved to be a risk factor for both severe post-discharge adverse event (OR: 2.40, 95% CI: 1.87 – 3.07, P<0.0001) and readmission (OR = 1.77, 95% CI: 1.46 – 2.14, P<0.0001).
Conclusions: Non-home discharge patients suffered from higher rates of adverse events and 30-day readmissions.
Patient Care: Elucidating and raising awareness regarding the connection between nonhome discharge destinations and adverse events could spur a bundle of targeted quality improvement measures to facilitate increased connection between hospitals and facilities or encourage surgeons to discharge their patients to home.
Learning Objectives: Following this presentation, viewers should be able to understand the association between discharge to a nonhome destination and readmission and severe adverse event rates.