Home Versus Rehabilitation: Factors that Influence Disposition After Minimally Invasive Surgery in Adult Spinal Deformity Surgery

Abstract

Minimally invasive surgery (MIS) correction for adult spinal deformity (ASD) may reduce the need the need for postoperative skilled nursing facility (SNF) or inpatient rehabilitation (IR) placement following surgery. The likelihood of requiring placement in a facility rather than home disposition may be influenced by various factors. In addition, the associations between discharge location and outcomes and complication rates have not been elucidated in these patients. In this study, we aimed to define factors predicting disposition to an SNF/IR and to elucidate the rates of complications occurring in patients sent to home versus to a facility. A retrospective review of a multicenter ASD database, which included patients who underwent surgery between 2009 and 2014. Inclusion criteria were age >18 years, MIS as part of index surgery, location of discharge, and at least 1 of the following: pelvic tilt >20°, sagittal vertical axis >5 cm, pelvic incidence-lumbar lordosis mismatch >10, or lumbar scoliosis >20°. Patients with a 2-year follow-up were included. Preoperative demographic and radiographic data, postoperative (<30 day) complications, and health-related quality of life were analyzed. A total of 182 patients met our inclusion criteria, including 113 who were discharged to home and 69 who were discharged to an SNF/IR. Older patients (>50 years) were more likely to be discharged to an SNF/IR (P= 0.043). Those aged >70 years were 6-fold more likely to go to an SNF/IR. No association was identified between discharge to an SNF/IR and any radiographic parameters except preoperative pelvic tilt (odds ratio [OR], 1.11; P= 0.009). Staged cases were more likely to be discharged to an SNF/IR (OR, 3.24; 95% confidence interval, 1.11-9.46; P= 0.032); otherwise, there was no difference in levels treated, operating time, estimated blood loss, osteotomy, or length of hospital stay. Patients requiring discharge to an SNF/IR had a higher rate of complications (58% vs. 39.8%; P= 0.017), including major complications (19.5% vs. 42%; P= 0.001), perioperative complications (14.2% vs. 31.9%; P= 0.004) and infections (3.5% vs. 13%; P= 0.016). Patients discharged to an SNF/IR had a higher rate of revision (19.5% vs. 33%; P= 0.035). Health-related quality of life measures were similar regardless of disposition. Older patients and those undergoing staged MIS deformity correction have a higher likelihood of postoperative disposition to an SNF/IR. Complications occurred more commonly in those patients requiring transfer to an SNF/IR after hospitalization.