Abstract
Early discharge (ED) has emerged and gained popularity in spine surgery. However, the benefits of ED in lumbar fusion have not yet been validated by large cohort studies. To evaluate the effects of ED on readmissions and reoperations in lumbar fusion, this study utilized a national database to enroll patients who had undergone lumbar fusion surgery at age 50–70 years, and grouped them into an ED group or a comparison group. In the comprehensive follow-up of 180 days post-operation, the two groups were compared. There were 18,008 patients in the cohort, including 2172 in the ED group and 15,836 in the comparison group. The ED group was slightly younger (59.9 vs. 60.7 years, p < 0.001), more male predominant (44.9% vs. 36.9%, p < 0.001), and had fewer medical comorbidities. The ED group had less incidences of readmission than the comparison group. (Crude hazard ratio = 0.73, and adjusted HR = 0.75, both p < 0.001). Overall, the cumulative incidences of readmission in the ED group (9.5%) were lower than those in the comparison group (12.8%, p < 0.001), whereas reoperations were insignificantly different (1.5% vs. 1.2%, p = 0.189). For patients aged 50–70 years and who require lumbar fusion surgery, ED could yield a 25% reduced risk of readmission for any cause within 180 days post-operation. Since the reoperation rates remained similar, our results suggest that ED may be a promising option for elderly patients undergoing lumbar spinal fusion surgery.
Highlights
Lumbar spinal arthrodesis is one of the most common fusion surgeries of the spine performed in the modern era
2172 patients were categorized into the early discharge (ED) group, who had less than 72 h of hospitalization for the surgery
The comparison group and the ED group had some differences in gender composition, age, and medical comorbidities (Table 1)
Summary
Lumbar spinal arthrodesis is one of the most common fusion surgeries of the spine performed in the modern era. There have been many emerging technologies, such as minimally invasive approaches, low profile instrumentations, and biologics, to facilitate the process of recovery during the past couple of decades [1,2,3,4,5,6]. The concept of early discharge (ED) has been introduced into the field of spine surgery in the past several years [7,8,9,10,11]. By incorporation of strategic management peri-operatively, the early discharge (ED) approach has aimed to raise the efficiency of the entire treatment process so that the patients could recover better [12,13,14]. Public Health 2020, 17, 1335; doi:10.3390/ijerph17041335 www.mdpi.com/journal/ijerph
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