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  • Discharge to Rehabilitation Reduces Readmission Rates in Elective Spinal Surgery: Predictors of Discharge to Rehabilitation or Skilled Care Facilities

    Final Number:

    Nicholas B. Abt BS; Brandon A. McCutcheon MD, MPP; Panagiotis Kerezoudis; Meghan Murphy MD; Ross Puffer MD; Patrick R. Maloney MD; Mohamad Bydon MD

    Study Design:

    Subject Category:

    Meeting: Section on Disorders of the Spine and Peripheral Nerves 2016 Annual Meeting

    Introduction: Identification of appropriate postoperative discharge location is crucial for patient recovery and directly impacts healthcare costs. To determine independent discharge predictors to rehabilitation or skilled care (SC) facilities and how discharge location affects unplanned readmission and/or reoperation rates. The study objective is to improve postoperative discharge planning and management strategies.

    Methods: All elective spinal surgery patients were analyzed from the American College of Surgeons National Surgical Quality Improvement Program databases between January 1, 2006 and December 31, 2012. Multivariable logistic regression was used to assess for discharge predictors to rehabilitation or SC versus home, and the odds of 30-day unplanned readmission and/or reoperation with respect to discharge destination.

    Results: Of 34,023 elective spinal surgery patients, discharge locations were: 30,606 patients to home, 1,674 patients to rehabilitation, and 1,743 patients to SC. The patients discharged home had the lowest complication rate (4.49%) versus rehabilitation (18.22%) and SC facilities (16.41%;p<0.001). Following multivariable regression analysis, there was a significant odds increase of discharge to rehabilitation for age (OR=1.08;p<0.001), men (OR=1.74;p<0.001), current smoking (OR=1.33;p=0.040), ASA class three (OR=3.15;p=0.030) and four (OR=8.14;p<0.001), diabetics on oral (OR=1.37;p=0.020) or insulin therapy (OR=1.76;p=0.001), operation time (OR=1.005;p<0.001), having a previous operation within 30 days (OR=3.31;p=0.004), total hospital LOS (OR=1.02;p<0.001), preoperative neurologic morbidity (OR=2.13;p<0.001), and having at least one postoperative morbidity (OR=2.93;p<0.001). Independent factors associated with increased discharge odds to SC included all the above plus BMI (OR=1.02;p=0.005), preoperative renal morbidity (OR=3.26;p=0.034), and preoperative hemato-oncologic morbidity (OR=1.82;p=0.007). There were 804 (4.06%) 30-day unplanned readmissions and 822 (2.45%) unplanned reoperations. Discharge to rehabilitation decreased the odds of 30-day unplanned readmission (OR=0.41;p=0.008) and had no significant effect if discharged to SC. Neither rehabilitation nor SC demonstrated significant odds changes of 30-day unplanned reoperation.

    Conclusions: Consideration of discharge predictors, along with the complete clinical picture, should be used to determine discharge location. Discharge to rehabilitation was significantly associated with decreased 30-day unplanned readmission odds. Following elective spinal surgery, utilizing rehabilitation facilities might be an avenue to decrease readmissions and healthcare costs.

    Patient Care: - Discharge to rehabilitation and decreased readmission rates accelerate patient recovery and decrease risk of reoperation. - Utilizing rehabilitation facilities might be an avenue of decreasing healthcare costs - Careful discharge disposition planning will aid in delivering high quality postoperative care.

    Learning Objectives: - Discharge to a rehabilitation facility was significantly associated with decreased odds of 30-day unplanned readmission, with no significant effect on reoperation - Skilled care facility discharge did not influence 30-day unplanned readmission or reoperation odds - Following elective spinal surgery, utilizing rehabilitation facilities might be an avenue to decrease readmissions and healthcare costs.


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