Predictors of nonroutine discharge among patients undergoing surgery for grade I spondylolisthesis: insights from the Quality Outcomes Database

Restricted access

OBJECTIVE

Discharge to an inpatient rehabilitation facility or another acute-care facility not only constitutes a postoperative challenge for patients and their care team but also contributes significantly to healthcare costs. In this era of changing dynamics of healthcare payment models in which cost overruns are being increasingly shifted to surgeons and hospitals, it is important to better understand outcomes such as discharge disposition. In the current article, the authors sought to develop a predictive model for factors associated with nonroutine discharge after surgery for grade I spondylolisthesis.

METHODS

The authors queried the Quality Outcomes Database for patients with grade I lumbar degenerative spondylolisthesis who underwent a surgical intervention between July 2014 and June 2016. Only those patients enrolled in a multisite study investigating the impact of fusion on clinical and patient-reported outcomes among patients with grade I spondylolisthesis were evaluated. Nonroutine discharge was defined as those who were discharged to a postacute or nonacute-care setting in the same hospital or transferred to another acute-care facility.

RESULTS

Of the 608 patients eligible for inclusion, 9.4% (n = 57) had a nonroutine discharge (8.7%, n = 53 discharged to inpatient postacute or nonacute care in the same hospital and 0.7%, n = 4 transferred to another acute-care facility). Compared to patients who were discharged to home, patients who had a nonroutine discharge were more likely to have diabetes (26.3%, n = 15 vs 15.7%, n = 86, p = 0.039); impaired ambulation (26.3%, n = 15 vs 10.2%, n = 56, p < 0.001); higher Oswestry Disability Index at baseline (51 [IQR 42–62.12] vs 46 [IQR 34.4–58], p = 0.014); lower EuroQol-5D scores (0.437 [IQR 0.308–0.708] vs 0.597 [IQR 0.358–0.708], p = 0.010); higher American Society of Anesthesiologists score (3 or 4: 63.2%, n = 36 vs 36.7%, n = 201, p = 0.002); and longer length of stay (4 days [IQR 3–5] vs 2 days [IQR 1–3], p < 0.001); and were more likely to suffer a complication (14%, n = 8 vs 5.6%, n = 31, p = 0.014). On multivariable logistic regression, factors found to be independently associated with higher odds of nonroutine discharge included older age (interquartile OR 9.14, 95% CI 3.79–22.1, p < 0.001), higher body mass index (interquartile OR 2.04, 95% CI 1.31–3.25, p < 0.001), presence of depression (OR 4.28, 95% CI 1.96–9.35, p < 0.001), fusion surgery compared with decompression alone (OR 1.3, 95% CI 1.1–1.6, p < 0.001), and any complication (OR 3.9, 95% CI 1.4–10.9, p < 0.001).

CONCLUSIONS

In this multisite study of a defined cohort of patients undergoing surgery for grade I spondylolisthesis, factors associated with higher odds of nonroutine discharge included older age, higher body mass index, presence of depression, and occurrence of any complication.

ABBREVIATIONS ASA = American Society of Anesthesiologists; AUC = area under the curve; BMI = body mass index; EQ-5D = EuroQol-5D; IQR = interquartile range; NRS = numeric rating scale; ODI = Oswestry Disability Index; PRO = patient-reported outcome; QOD = Quality Outcomes Database; SNF = skilled nursing facility.
Article Information

Contributor Notes

Correspondence Mohamad Bydon: Mayo Clinic, Rochester, MN. bydon.mohamad@mayo.edu.INCLUDE WHEN CITING Published online December 6, 2019; DOI: 10.3171/2019.9.SPINE19644.Disclosures Dr. Bisson is a consultant for nView and MiRus, and also has direct stock ownership on those companies. She receives clinical or research support for the study described (includes equipment or material) from the Neurosurgery Research and Education Foundation (NREF). Dr. Chan receives non–study-related research support from Orthofix, Inc. Dr. Foley is a consultant for Medtronic; has direct stock ownership in Digital Surgery Systems, Discgenics, DuraStat, LaunchPad Medical, Medtronic, NuVasive, nView Medical, Practical Navigation/Fusion Robotics, SpineWave, TDi, and Triad Life Sciences; is a patent holder with Medtronic and NuVasive; and is a member of the board of directors of Digital Surgery Systems, Discgenics, DuraStat, LaunchPad Medical, nView Medical, Practical Navigation/Fusion Robotics, TDi, and Triad Life Sciences. Dr. Fu is a consultant for SI Bone, Globus, and Johnson & Johnson. Dr. Glassman is an employee of Norton Healthcare; is a consultant for K2M and Medtronic; is a patent holder with Medtronic, from which he receives royalties; and receives clinical or research support for the study described (includes equipment or material) from NuVasive. Dr. Haid has direct stock ownership in Globus Medical, NuVasive, Paradigm Spine, Spine Universe (Vertical Health), and SpineWave. He also receives royalties for IP; Globus Lateral and TLIF Interbody Implants; Medtronic Atlantis, Venture Anterior Plates; Medtronic Prestige ST and LP; NuVasive ALIF; Post Pedicle Screw Reline; and multiple textbooks. He sits on the board of directors for the AANS, Lumbar Spine Research Society, and NREF as well. Dr. Mummaneni is a consultant for DePuy Synthes, Globus, and Stryker; has direct stock ownership in Spinicity-ISD; receives clinical or research support for the study described (includes equipment or material) from NREF; receives support of a non–study-related clinical or research effort that he oversees from ISSG and AOSpine; receives honoraria from Spineart; and receives royalties from Thieme Publishing, Springer Publishing, and DePuy Synthes. Dr. Park is a consultant for Globus and NuVasive; receives royalties from Globus; and receives support of a non–study-related clinical or research effort that he oversees from Pfizer and Vertex. Dr. Potts is a patent holder with Medtronic. Dr. C. Shaffrey has direct stock ownership with NuVasive; is a patent holder with NuVasive, Medtronic, Zimmer Biomet, and SI Bone; and is a consultant for NuVasive, Medtronic, and SI Bone. Dr. Slotkin is a consultant for Medtronic and Stryker. Dr. Wang is a consultant for DePuy-Synthes Spine, K2M, Stryker, and Spineology; has direct stock ownership in ISD and Medical Devices Partners; and is a patent holder with DePuy-Synthes Spine.
Headings
References
  • 1

    Archer KRWegener STSeebach CSong YSkolasky RLThornton C: The effect of fear of movement beliefs on pain and disability after surgery for lumbar and cervical degenerative conditions. Spine (Phila Pa 1976) 36:155415622011

    • Search Google Scholar
    • Export Citation
  • 2

    Asher ALKerezoudis PMummaneni PVBisson EFGlassman SDFoley KT: Defining the minimum clinically important difference for grade I degenerative lumbar spondylolisthesis: insights from the Quality Outcomes Database. Neurosurg Focus 44(1):E22018

    • Search Google Scholar
    • Export Citation
  • 3

    Bihorac AOzrazgat-Baslanti TEbadi AMotaei AMadkour MPardalos PM: MySurgeryRisk: Development and validation of a machine-learning risk algorithm for major complications and death after surgery. Ann Surg 269:6526622019

    • Search Google Scholar
    • Export Citation
  • 4

    Bozic KJWard LVail TPMaze M: Bundled payments in total joint arthroplasty: targeting opportunities for quality improvement and cost reduction. Clin Orthop Relat Res 472:1881932014

    • Search Google Scholar
    • Export Citation
  • 5

    Chan AK: Erratum. Laminectomy alone versus fusion for grade 1 lumbar spondylolisthesis in 426 patients from the prospective Quality Outcomes Database. J Neurosurg Spine 30:8588592019

    • Search Google Scholar
    • Export Citation
  • 6

    Chan AKBisson EFBydon MGlassman SDFoley KTPotts EA: A comparison of minimally invasive transforaminal lumbar interbody fusion and decompression alone for degenerative lumbar spondylolisthesis. Neurosurg Focus 46(5):E132019

    • Search Google Scholar
    • Export Citation
  • 7

    Chan AKBisson EFBydon MGlassman SDFoley KTPotts EA: Obese patients benefit, but do not fare as well as nonobese patients, following lumbar spondylolisthesis surgery: an analysis of the Quality Outcomes Database. Neurosurgery [epub ahead of print] 2018

    • Search Google Scholar
    • Export Citation
  • 8

    Chan AKBisson EFBydon MGlassman SDFoley KTPotts EA: Women fare best following surgery for degenerative lumbar spondylolisthesis: a comparison of the most and least satisfied patients utilizing data from the Quality Outcomes Database. Neurosurg Focus 44(1):E32018

    • Search Google Scholar
    • Export Citation
  • 9

    Chou RBaisden JCarragee EJResnick DKShaffer WOLoeser JD: Surgery for low back pain: a review of the evidence for an American Pain Society Clinical Practice Guideline. Spine (Phila Pa 1976) 34:109411092009

    • Search Google Scholar
    • Export Citation
  • 10

    Collins GSReitsma JBAltman DGMoons KGM: Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD): the TRIPOD statement. Eur Urol 67:114211512015

    • Search Google Scholar
    • Export Citation
  • 11

    de Pablo PLosina EPhillips CBFossel AHMahomed NLingard EA: Determinants of discharge destination following elective total hip replacement. Arthritis Rheum 51:100910172004

    • Search Google Scholar
    • Export Citation
  • 12

    Devin CJBydon MAlvi MAKerezoudis PKhan ISivaganesan A: A predictive model and nomogram for predicting return to work at 3 months after cervical spine surgery: an analysis from the Quality Outcomes Database. Neurosurg Focus 45(5):E92018

    • Search Google Scholar
    • Export Citation
  • 13

    Drazin DLagman CBhargava SNuño MKim TTJohnson JP: National trends following decompression, discectomy, and fusion in octogenarians and nonagenarians. Acta Neurochir (Wien) 159:5175252017

    • Search Google Scholar
    • Export Citation
  • 14

    EuroQol Group: EuroQol—a new facility for the measurement of health-related quality of life. Health Policy 16:1992081990

  • 15

    Fairbank JCPynsent PB: The Oswestry Disability Index. Spine (Phila Pa 1976) 25:294029522000

  • 16

    Forrest GFuchs MGutierrez AGirardy J: Factors affecting length of stay and need for rehabilitation after hip and knee arthroplasty. J Arthroplasty 13:1861901998

    • Search Google Scholar
    • Export Citation
  • 17

    Harrell FE Jr: Regression Modeling Strategies: With Applications to Linear Models Logistic and Ordinal Regression and Survival Analysis. Berlin: Springer International Publishing2015

    • Search Google Scholar
    • Export Citation
  • 18

    Jones CAVoaklander DCJohnston DWSuarez-Almazor ME: The effect of age on pain, function, and quality of life after total hip and knee arthroplasty. Arch Intern Med 161:4544602001

    • Search Google Scholar
    • Export Citation
  • 19

    Kanaan SFYeh HWWaitman RLBurton DCArnold PMSharma NK: Predicting discharge placement and health care needs after lumbar spine laminectomy. J Allied Health 43:88972014

    • Search Google Scholar
    • Export Citation
  • 20

    Karhade AVOgink PThio QBroekman MCha TGormley WB: Development of machine learning algorithms for prediction of discharge disposition after elective inpatient surgery for lumbar degenerative disc disorders. Neurosurg Focus 45(5):E62018

    • Search Google Scholar
    • Export Citation
  • 21

    Kersting RC: Impact of social support, diversity, and poverty on nursing home utilization in a nationally representative sample of older Americans. Soc Work Health Care 33:67872001

    • Search Google Scholar
    • Export Citation
  • 22

    Langley GBSheppeard H: The visual analogue scale: its use in pain measurement. Rheumatol Int 5:1451481985

  • 23

    Lunenfeld BStratton P: The clinical consequences of an ageing world and preventive strategies. Best Pract Res Clin Obstet Gynaecol 27:6436592013

    • Search Google Scholar
    • Export Citation
  • 24

    Mancuso CADuculan RCraig CMGirardi FP: Psychosocial variables contribute to length of stay and discharge destination after lumbar surgery independent of demographic and clinical variables. Spine (Phila Pa 1976) 43:2812862018

    • Search Google Scholar
    • Export Citation
  • 25

    Martin BIMirza SKSpina NSpiker WRLawrence BBrodke DS: Trends in lumbar fusion procedure rates and associated hospital costs for degenerative spinal diseases in the United States, 2004 to 2015. Spine (Phila Pa 1976) 44:3693762019

    • Search Google Scholar
    • Export Citation
  • 26

    McGirt MJParker SLChotai SPfortmiller DSorenson JMFoley K: Predictors of extended length of stay, discharge to inpatient rehab, and hospital readmission following elective lumbar spine surgery: introduction of the Carolina-Semmes Grading Scale. J Neurosurg Spine 27:3823902017

    • Search Google Scholar
    • Export Citation
  • 27

    Meyerding HW: Diagnosis and roentgenologic evidence in spondylolisthesis. Radiology 20:1081201933

  • 28

    Mummaneni PVBisson EFKerezoudis PGlassman SFoley KSlotkin JR: Minimally invasive versus open fusion for Grade I degenerative lumbar spondylolisthesis: analysis of the Quality Outcomes Database. Neurosurg Focus 43(2):E112017

    • Search Google Scholar
    • Export Citation
  • 29

    Mummaneni PVBydon MAlvi MAChan AKGlassman SDFoley KT: Predictive model for long-term patient satisfaction after surgery for grade I degenerative lumbar spondylolisthesis: insights from the Quality Outcomes Database. Neurosurg Focus 46(5):E122019

    • Search Google Scholar
    • Export Citation
  • 30

    Munin MCKwoh CKGlynn NCrossett LRubash HE: Predicting discharge outcome after elective hip and knee arthroplasty. Am J Phys Med Rehabil 74:2943011995

    • Search Google Scholar
    • Export Citation
  • 31

    National Research Council: Difference between life expectancy in the United States and other high-income countries in Explaining Divergent Levels of Longevity in High-Income Countries. Washington, DC: National Academies Press2011 pp 725

    • Search Google Scholar
    • Export Citation
  • 32

    Orhurhu VUrits IOlusunmade MOwais KJones MGalasso A: Trends of co-morbid depression in hospitalized patients with failed back surgery syndrome: an analysis of the Nationwide Inpatient Sample. Pain Ther 7:2172262018

    • Search Google Scholar
    • Export Citation
  • 33

    Phelan MPMeldon SBrenner RDeadwiler MAdams KSimon JF: 120 Skilled nursing facility 3-day waiver pilot: Direct admission to skilled nursing facilities from the emergency department avoids hospital admissions and decreases costs. Ann Emerg Med 72 Suppl:S512018

    • Search Google Scholar
    • Export Citation
  • 34

    Smith ALKulhari AWolfram JAFurlan A: Impact of insurance precertification on discharge of stroke patients to acute rehabilitation or skilled nursing facility. J Stroke Cerebrovasc Dis 26:7117162017

    • Search Google Scholar
    • Export Citation
  • 35

    Tanenbaum JELubelski DRosenbaum BPThompson NRBenzel ECMroz TE: Predictors of outcomes and hospital charges following atlantoaxial fusion. Spine J 16:6086182016

    • Search Google Scholar
    • Export Citation
  • 36

    Zheng FCammisa FP JrSandhu HSGirardi FPKhan SN: Factors predicting hospital stay, operative time, blood loss, and transfusion in patients undergoing revision posterior lumbar spine decompression, fusion, and segmental instrumentation. Spine (Phila Pa 1976) 27:8188242002

    • Search Google Scholar
    • Export Citation
TrendMD
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 509 509 74
Full Text Views 50 50 11
PDF Downloads 28 28 9
EPUB Downloads 0 0 0
PubMed
Google Scholar