300. Continued inpatient care following elective anterior cervical discectomy and fusion increases the risk of 30-day readmissions and post-discharge complications

Abstract

BACKGROUND CONTEXT With a shift toward value-based and bundled-payment models, identification of areas of cost and quality improvement will be required. Though abundant literature is present on the predictors of discharge destinations, few studies have studied the impact of discharge to an inpatient care facility (skilled-care or rehabilitation) on post-discharge outcomes following elective spine surgery. PURPOSE We sought to collate evidence using a large national multi-center surgical database to assess the clinical impact of continued post-discharged inpatient care (skilled care facility or inpatient rehabilitation unit) on 30-day complications, readmissions and mortality after elective anterior cervical discectomy and fusion (ACDF). STUDY DESIGN/SETTING This was a retrospective study done using the 2015-2016 American College of Surgeons (ACS) – National Surgical Quality Improvement Program (NSQIP) database. PATIENT SAMPLE Current Procedural Terminology (CPT) codes for ACDF (CPT- 22551, 22552) were used to identify patients from the database. Only elective ACDFs being done for ≤3 levels were included in the study. Patients undergoing additional posterior cervical spine procedures (instrumentation, laminectomy, laminotomy, etc.) were excluded from the analysis. In addition, patients undergoing surgery for cervical fracture, malignancy and spinal deformity were also excluded. Finally data was filtered to remove for missing variables to prevent any confounding in analysis. Discharge disposition was defined as discharge to an inpatient care facility (skilled care or rehabilitation) vs home. Those patients being discharged to other destinations such as acute care hospitals, unskilled facilities and assisted living facilities were excluded from the analysis to ensure that the results are relevant to the objective of the study. OUTCOME MEASURES Thirty day postdischarge complications, reoperations, redmissions and mortality. METHODS Multivariate logistic regression analyses were used to assess for the independent impact of discharge to an inpatient care facility vs home on the odds of experiencing 30-day post-discharge complications, readmissions, reoperations and mortality, while controlling for preoperative, intraoperative and predischarge clinical factors and patient characteristics. RESULTS A total of 15,624 patients were finally included for analysis. A total of 459 (2.9%) patients were discharged to an inpatient care (skilled care or rehabilitation) facility. Age of ≥65 years, Black or African-American race, partially dependent or totally dependent functional health status, a LOS ≥3 days, a total operative time>150 mins, ASA grade>II and inpatient surgery were significant predictors for a discharge to skilled care/rehabilitation facility. Following adjustment for predischarge clinical characteristics, discharge to an inpatient care facility was an independent significant risk factor for renal complications (OR 8.22 [95% CI 1.84-36.7]; p=0.006) and 30-day readmissions (OR 1.63 [95% CI 1.09-2.42]; p=0.016). CONCLUSIONS Discharge to inpatient care facilities following elective ACDF is associated with higher odds of renal complications and 30-day readmissions. These results stress the importance of careful patient selection prior to discharge to inpatient care facilities to minimize the risk of complications. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.