Study Design:
Ambispective cohort study.
Objective:
Patients spend on average 3 to 7 days in hospital after lumbar fusion
surgery. Patients who are unable to be discharged home may require a
prolonged hospital stay while awaiting a bed at a rehabilitation facility,
adding cost and imposing a considerable burden on the health care system.
Our objective is to identify patient or procedure related predictors of
discharge destination for patients undergoing posterior lumbar fusion.
Methods:
Analysis of data from the Canadian Spine Outcomes and Research Network.
Patients who underwent lumbar fusion for degenerative pathology between 2008
and 2015 were identified. Multivariable logistic regression analysis was
used to identify independent predictors of the discharge destination.
Results:
A total of 643 patients were identified from the database, 87.1% of the
patients (N = 560) were discharged home while 12.9% (N = 83) required
discharge to nonhome facilities. Using multivariate logistic regression
analysis, the predictors for discharge to a facility rather than home were
identified including: increasing age (odds ratio [OR] 1.045, 95% confidence
interval [CI] 1.017 -1.075,
P
< .002), increasing body
mass index (BMI) (OR 1.069, 95% CI 1.021 -1.118,
P
<
.004), increasing disability score (OR 1.025, 95% CI 1.004 -1.046,
P
< .02), living alone preoperatively (OR 1.916, 95%
CI 1.004-3.654,
P
< .05), increasing operating time (OR
1.005, 95% CI 1.003 -1.008,
P
< .0001), need for blood
transfusion (OR 3.32, 95% CI 1.687-6.528,
P
< .001), and
multilevel fusion surgery (OR 1.142, 95% CI 1.007 -1.297,
P
< .04).
Conclusions:
Older age, high BMI, living alone, high disability score, extended surgical
time, blood transfusion, and multilevel fusion are significant factors that
increase the odds of being discharged to facilities other than home.
Level of Evidence:
Level 3.