Predictors of Discharge to Post-Acute Rehabilitation Following Spinal Surgery: Insights from a National Database Analysis

Introduction: Many patients may experience longer-than-necessary hospitalization following spinal surgery as a result of both evolving provider judgment regarding patient disposition and delays in securing discharge approval, insurance coverage, or facility acceptance for rehabilitation services. This study utilized a nationwide surgical database to examine various demographic and clinical factors that may predispose patients to such postoperative dispositions, in an attempt to increase predictability of requiring such services and streamline the process for patients.

Methods: Data was aggregated from the National Surgical Quality Improvement Program (NSQIP) database, focusing on patients with spinal surgeries for deformity correction between 2006 and 2021. An analytical tool was developed to analyze thousands of patient records, identifying factors associated with discharge to post-acute rehabilitation. Pertinent demographic and clinical variables were analyzed, including age, sex, race, diabetes, transfusion history, functional status, bleeding disorders, and sepsis.

Results: 2808 patients underwent deformity spine surgery, of which 33% required postoperative discharge to rehab facilities or other non-home discharges. The proportion of patients discharged to rehabilitation facilities generally increased with age, rising from 0.578 in the 70–90 age group (n=690) to 0.75 in the 80–90 age group (n=104). Among patients with diabetes, females had a higher non-home discharge proportion (0.527) compared to males (0.446). Diabetes combined with a history of transfusion significantly increased the non-home discharge proportion regardless of sex (0.857, n=7). Black patients with diabetes were more likely than patients overall to require rehab (0.69, n=42, vs 0.493, n=351). Patients with both diabetes and bleeding disorders exhibited a high discharge proportion, especially those without sepsis within 48 hours prior to surgery (0.91, n=11). Conversely, the proportion was significantly lower for patients without diabetes, bleeding disorders, transfusion history, or sepsis.

Conclusion : The study identifies age, sex, race, diabetes status, functional status, transfusion history, bleeding disorders, and sepsis as significant factors influencing the likelihood of discharge to non-home locations post spinal surgery for deformity correction. These findings underscore the need for tailored discharge planning and early resource allocation to support high-risk patient groups effectively and efficiently. The use of a national database confers additional confidence in outlining decisions regarding postoperative patient disposition for higher risk patients.