Research Fellow Rothman Orthopaedic Institute Rothman Orthopaedic Institute
Disclosure(s):
Joydeep Baidya, BS: No financial relationships to disclose
Introduction: Utilization of posterior cervical decompression and fusion (PCDF) for degenerative disease has increased, partly due to an expansion of age and medical complexity eligibility criteria. While this change allows more patients with cervical radiculopathy and myelopathy to benefit from PCDF, it also exposes a more vulnerable population to perioperative risk—including non-home discharge disposition. Anticipating that a patient may be at risk for non-home disposition can provide important advantages to surgeons during the inpatient period. The goal of this study was to characterize risk factors associated with requiring non-home disposition after PCDF.
Methods: This study utilized CPT codes to retrospectively identify adult patients who underwent PCDF (2017-2022) at a tertiary care center. Patients undergoing surgery for trauma, tumor, or infection or using anterior-posterior approaches were excluded. Eligible patients were categorized into three groups—disposition to 1.) home, 2.) home with home health care (HHC), or 3.) inpatient rehab/skilled nursing facility (IPR/SNF). Patient and surgical characteristics were compared with bivariate analysis between groups. Significant differences were further analyzed with multivariate regression.
Results: 378 patients were included. Disposition was 208 home, 79 HHC, and 91 IPR/SNF. All demographic variables, with the exception of smoking status, were different between groups. Myelopathy as indication, LOS, and OR time were greatest in the IPR/SNF group. On logistic regression, age (OR 1.09, 95% CI [1.04-1.14]; p < 0.001), CCI (OR 1.27, 95% CI [1.01-1.60]; p = 0.042), and LOS (OR 1.76, 95% CI [1.53-2.06]; p < 0.001) were found to be positively associated with discharge to IPR/SNF.
Conclusion : This study identified advanced age, medical comorbidities, and prolonged LOS as independent risk factors for non-home discharge following PCDF. Previous literature has associated non-home discharge with complications and readmissions. In light of the current findings, this association may be due to IPR/SNF patients simply being more medically complex and thus having more risk of complications/readmissions. Future research should be aimed at further investigating these risks/relationships. Regardless, it is important to identify patients with these risk factors undergoing PCDF in order to optimize them in the perioperative setting.