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Predictors of a Non-home Discharge Destination Following Spinal Fusion for Adolescent Idiopathic Scoliosis (AIS)

Malik, Azeem Tariq, MBBS; Kim, Jeffery, MD; Yu, Elizabeth, MD; Khan, Safdar N., MD

doi: 10.1097/BRS.0000000000002886
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Study Design. Retrospective cohort study.

Objective. Analyze risk factors associated with a non-home discharge following spinal fusions in adolescent idiopathic scoliosis (AIS).

Summary of Background Data. Current evidence is limited with regard to which patient-level and provider/hospital-level factors predict a non-home discharge disposition following spinal fusions in AIS. Identifying these factors can allow providers to identify which patients would ultimately require facility care and can be discharged early to these facilities to reduce hospital costs.

Methods. The 2012 to 2016 American College of Surgeons—National Surgical Quality Improvement Program Pediatric database was queried using Current Procedural Terminology codes for posterior spinal fusions (22800, 22802, and 22804) and anterior spinal fusions (22808, 22810, and 22812). Patients were categorized into those receiving a posterior-only fusion, anterior-only fusion, and combined anterior-posterior fusion. Only patients aged 10 to 18 undergoing corrective surgery for idiopathic scoliosis were included in the study.

Results. Out of a total of 8452 patients—90 (1.1%) were discharged to a destination other than home (skilled-care facility, separate acute care unit, and/or rehabilitation unit). Following multivariate analysis, children with a body mass index of 20 to 30 (P = 0.002) or >30 (P = 0.003), structural pulmonary abnormality (P = 0.030), past history of childhood cancer (P = 0.018), an ASA grade >II (P<0.001), undergoing a revision surgery versus a primary surgery (P = 0.039), a length of stay >4 days (P<0.001), and the occurrence of a predischarge complication (P = 0.003) were independent predictors associated with a non-home discharge disposition.

Conclusion. In the current era of evolving health-care in which there is an increased focus toward decreasing costs, providers should consider utilizing these data to preoperatively identify patients who can be discharged to facility, and tailor an appropriate postoperative course of care aimed at expediting discharge processes to curb the financial burden of a prolonged length of stay.

Level of Evidence: 3

Children with higher BMI, past history of cancer, structural pulmonary abnormality, higher ASA grades, undergoing a revision surgery, having a prolonged length of stay and experiencing a predischarge complication were more likely to be discharged to a destination other than home following spinal fusions for adolescent idiopathic scoliosis (AIS).

Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH.

Address correspondence and reprint requests to Safdar N. Khan, MD, The Benjamin R. and Helen Slack Wiltberger Endowed Chair in Orthopaedic Spine Surgery, Associate Professor and Chief, Division of Spine Surgery Department of Orthopaedic Surgery, Adjunct Associate Professor, Department of Integrated Systems Engineering, Clinical Faculty, Spine Research Institute (https://spine.osu.edu/about/our-team), Wexner Medical Center at The Ohio State University, Columbus, OH; E-mail: Safdar.Khan@osumc.edu

Received 30 July, 2018

Accepted 31 August, 2018

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: grants.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.