Discharge Destination as a Predictor of Postoperative Outcomes and Readmission Following Posterior Lumbar Fusion.

Abstract

Posterior lumbar fusions are performed to treat various spinal deformities, degenerative diseases, fractures, infections, and tumors. The possibility of episode-based bundled payments for spine surgery necessitates analysis of the factors predicting readmissions and postoperative complications. Patients undergoing posterior lumbar fusion in the American College of Surgeons National Surgical Quality Improvement Program were queried via Current Procedural Terminology codes 22630, 22633, and 22612. Patients were grouped based on discharge destination, either to home/home health care or to a facility. Relevant demographics, comorbidities, perioperative statistics, and predischarge and postdischarge complications were compared. Multivariable logistic regression models for severe postdischarge complications and 30-day readmissions were created with the exposure of nonhome discharge. Patients discharged to nonhome destinations were significantly older (68.42 vs. 58.15 years; P < 0.0001), sicker (68.11% of patients had American Society of Anesthesiologists Physical Status Classification > 2 vs. 44.25%; P < 0.0001), more dependent (5.92% vs. 1.40%; P < 0.0001), and had significantly greater body mass indices (10.60% of patients had body mass index > 40 vs. 7.63%; P < 0.0001) than patients discharged home. Following discharge, patients in the nonhome discharge group experienced higher mortality (0.28% vs. 0.08%; P < 0.0001) and were more likely to experience a severe complication (5.96% vs. 2.85%; P < 0.0001), minor complication (4.59% vs. 1.74%; P < 0.0001), and readmission (8.92% vs. 4.78%; P < 0.0001). Nonhome discharge proved to be a risk factor for both readmission (odds ratio 1.43; 95% confidence interval 1.28-1.60; P < 0.0001) and severe postdischarge complication (odds ratio 1.73; 95% confidence interval 1.52-1.97; P < 0.0001). Nonhome discharge patients experienced higher rates of complications and 30-day readmissions.