Drivers for nonhome discharge in a consecutive series of 1502 patients undergoing 1- or 2-level lumbar fusion

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OBJECTIVE

Unexpected nonhome discharge causes additional costs in the current reimbursement models, especially to the payor. Nonhome discharge is also related to longer length of hospital stay and therefore higher healthcare costs to society. With increasing demand for spine surgery, it is important to minimize costs by streamlining discharges and reducing length of hospital stay. Identifying factors associated with nonhome discharge can be useful for early intervention for discharge planning. The authors aimed to identify the drivers of nonhome discharge in patients undergoing 1- or 2-level instrumented lumbar fusion.

METHODS

The electronic medical records from a single-center hospital administrative database were analyzed for consecutive patients who underwent 1- to 2-level instrumented lumbar fusion for degenerative lumbar conditions during the period from 2016 to 2018. Discharge disposition was determined as home or nonhome. A logistic regression analysis was used to determine associations between nonhome discharge and age, sex, body mass index (BMI), race, American Society of Anesthesiologists grade, smoking status, marital status, insurance type, residence in an underserved zip code, and operative factors.

RESULTS

A total of 1502 patients were included. The majority (81%) were discharged home. Factors associated with a nonhome discharge were older age, higher BMI, living in an underserved zip code, not being married, being on government insurance, and having more levels fused. Patients discharged to a nonhome facility had longer lengths of hospital stay (5.6 vs 3.0 days, p < 0.001) and significantly increased hospital costs ($21,204 vs $17,518, p < 0.001).

CONCLUSIONS

Increased age, greater BMI, residence in an underserved zip code, not being married, and government insurance are drivers for discharge to a nonhome facility after a 1- to 2-level instrumented lumbar fusion. Early identification and intervention for these patients, even before admission, may decrease the length of hospital stay and medical costs.

ABBREVIATIONS ASA = American Society of Anesthesiologists; EMR = electronic medical record; iEOC = index episode of care; LOS = length of stay.

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Contributor Notes

Correspondence Yoji Ogura: Norton Leatherman Spine Center, Louisville, KY. yojitotti1223@gmail.com.

INCLUDE WHEN CITING Published online July 31, 2020; DOI: 10.3171/2020.5.SPINE20410.

Disclosures Dr. Gum reports being an employee of Norton Healthcare; being a consultant for Medtronic, DePuy, K2M/Stryker, Acuity, PacMed, and NuVasive; receiving clinical or research support for the study described (includes equipment or material) from Intellirod, Integra, Pfizer, and the International Spine Study Group; having direct stock ownership in Cingulate Therapeutics; being a patent holder in Medtronic; and receiving royalties from Acuity. Dr. Crawford reports receiving royalties from Alphatec and NuVasive and being a consultant for NuVasive, Medtronic, and DePuy. Dr. Djurasovic reports receiving royalties from Medtronic and NuVasive; being a consultant for Medtronic and NuVasive; and receiving support of non–study-related clinical or research efforts overseen by the author from Pfizer and Cerapedics. Dr. Owens reports being a consultant for Medtronic and NuVasive; receiving royalties from NuVasive; and receiving clinical or research support for the study described (includes equipment or material) from Pfizer, Intellirod, TSRH, Alan L. and Jacqueline B. Stuart Spine Research, Erapedics, SRS, and Medtronic. Dr. Laratta reports being a consultant for Stryker, 4Web, Medtronic, NuVasive, K2M, Evolution Spine, and Spineart; receiving royalties from Evolution Spine; and having direct stock ownership in NuVasive and Alphatec. Mr. Brown reports being an employee of Norton Healthcare and receiving clinical or research support for the study described (includes equipment or material) from OREF, NIH, ISSG, SRS, TSRH, Pfizer, Lifesciences Corporation, IntelliRod, Cerapedics, Medtronic, Empirical Spine, and NeuroPoint Alliance. Ms. Daniels reports being an employee of Norton Healthcare and ThreeWire and receiving institutional funds for the study described from OREF, NIH, ISSG, SRS, TSRH, Pfizer, Lifesciences Corporation, IntelliRod, Cerapedics, Medtronic, Empirical Spine, and NeuroPoint Alliance. Dr. Dimar reports being a consultant for Medtronic, DePuy, and Stryker; being a patent holder in Medtronic; being on the speakers bureau for Medtronic, DePuy, and Stryker; receiving royalties from Medtronic; and having direct stock ownership in JNJ, ELY, GSK, Roche, Abbot, Abbie, and Pfizer. Dr. Glassman reports being an employee of Norton Healthcare; being a consultant for K2M/Stryker and Medtronic; being a patent holder in Medtronic; receiving clinical or research support for the study described (includes equipment or material) from NuVasive; receiving royalties from Medtronic and the American Spine Registry; and serving as chair and past president of the Scoliosis Research Society. Dr. Carreon reports being an employee of Norton Healthcare and the University of Southern Denmark; being a consultant for the National Spine Health Foundation; receiving institutional support of non–study-related clinical or research efforts overseen by the author from OREF, NIH, ISSG, SRS, TSRH, Pfizer, Lifesciences Corporation, IntelliRod, Cerapedics, Medtronic, Empirical Spine, and NeuroPoint Alliance; and nonfinancial relationships as a member of the editorial advisory boards for Spine Deformity, The Spine Journal, and Spine and a member of the University of Louisville IRB.

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