Discharge to Inpatient Care Facility Following Revision Posterior Lumbar Fusions-Risk Factors and Postdischarge Outcomes.

Abstract

Recent literature has denoted care in an inpatient facility after discharge to be linked with worse outcomes after elective primary lumbar and cervical fusions. No study has explored the risk factors and associated postdischarge outcomes after discharge to inpatient facility after revision posterior lumbar fusion. The 2012-2016 American College of Surgeons-National Surgical Quality Improvement Program were queried using Current Procedural Terminology codes for posterior lumbar fusions (22630, 22633, 22614) combined with Current Procedural Terminology codes for revision-22830 (exploration of spinal fusion), 22849 (reinsertion of spinal fixation device), 22850 (removal of posterior nonsegmental instrumentation), and 22852 (removal of posterior segmental instrumentation). Of 1170 patients who underwent revision posterior lumbar fusion, 253 (21.6%) were discharged to an inpatient care facility and 917 (78.4%) were discharged to home. Significant risk factors associated with discharge to inpatient care facility were age 60-69 years (odds ratio [OR] 3.62), age ≥70 years (OR 7.46), female gender (OR 1.61), partially dependent functional health status before surgery (OR 2.94), history of chronic obstructive pulmonary disease (OR 1.92), a length of stay >3 days (OR 3.13), and the occurrence of any predischarge complication (OR 4.10). Discharge to inpatient care facilities versus home was associated with a higher risk of experiencing any postdischarge complication (8.3% vs. 3.2%; OR 2.2). Providers should understand the need of construction of care pathways and reducing discharge to inpatient facilities to mitigate the risks of experiencing adverse outcomes and consequently reduce the financial burden on the health care system.