Predictors of home discharge after scheduled surgery for degenerative cervical myelopathy

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  • 1 Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec;
  • | 2 Canadian Spine Outcomes and Research Network, Markdale, Ontario;
  • | 3 Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedics Surgery, University of British Columbia, Vancouver, British Columbia;
  • | 4 University of Calgary, Calgary, Alberta;
  • | 5 London Health Science Centre, Western University, London, Ontario;
  • | 6 Department of Surgery, Dalhousie University, Halifax, Nova Scotia;
  • | 7 Canada East Spine Centre, Division of Neurosurgery, Zone 2, Horizon Health Network, Saint John, New Brunswick;
  • | 8 The Ottawa Hospital, Ottawa, Ontario;
  • | 9 Centre de Recherche CHU de Quebec, CHU de Quebec-Universite Laval, Quebec City, Quebec;
  • | 10 Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Edmonton, Alberta;
  • | 11 Department of Surgery, University of Toronto, Toronto, Ontario;
  • | 12 Divisions of Orthopaedic and Neurosurgery, University of Toronto, Toronto, Ontario;
  • | 13 Canada East Spine Centre, Saint John Orthopedics, Dalhousie Medicine New Brunswick, Saint John Campus, Saint John, New Brunswick; and
  • | 14 Department of Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
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OBJECTIVE

Degenerative cervical myelopathy (DCM) is an important public health issue. Surgery is the mainstay of treatment for moderate and severe DCM. Delayed discharge of patients after DCM surgery is associated with increased healthcare costs. There is a paucity of data regarding predictive factors for discharge destination after scheduled surgery for patients with DCM. The purpose of this study was to identify factors predictive of home versus nonhome discharge after DCM surgery.

METHODS

Patients undergoing scheduled DCM surgery who had been enrolled in a prospective DCM substudy of the Canadian Spine Outcomes and Research Network registry between January 2015 and October 2020 were included in this retrospective analysis. Patient data were evaluated to identify potential factors predictive of home discharge after surgery. Logistic regression was used to identify independent factors predictive of home discharge. A multivariable model was then used as a final model.

RESULTS

Overall, 639 patients were included in the initial analysis, 543 (85%) of whom were discharged home. The mean age of the entire cohort was 60 years (SD 11.8 years), with a BMI of 28.9 (SD 5.7). Overall, 61.7% of the patients were female. The mean length of stay was 2.72 days (SD 1.7 days). The final internally validated bootstrapped multivariable model revealed that younger age, higher 9-Item Patient Health Questionnaire score, lower Neck Disability Index scores, fewer operated levels, mJOA scores indicating mild disease, anterior cervical discectomy and fusion procedure, and no perioperative adverse effects were predictive of home discharge.

CONCLUSIONS

Younger age, less neck-related disability, fewer operated levels, more significant depression, less severe myelopathy, anterior cervical discectomy and fusion procedure, and no perioperative adverse effects are predictive of home discharge after surgery for DCM. These factors can help to guide clinical decision-making and optimize postoperative care pathways.

ABBREVIATIONS

ACDF = anterior cervical discectomy and fusion; ASA = American Society of Anesthesiologists; CSORN = Canadian Spine Outcomes and Research Network; DCM = degenerative cervical myelopathy; LOS = length of stay; mCCI = modified Charlson Comorbidity Index; mJOA = modified Japanese Orthopaedic Association; NDI = Neck Disability Index; PHQ-9 = 9-Item Patient Health Questionnaire.

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