P.123 Functional status in neurosurgery and out of hospital outcomes: insights from a 12 year, 2300 patient retrospective cohort study

Abstract

Background: Limited information exists in neurosurgery regarding the association between functional status at hospital discharge and adverse events following discharge. Methods: A retrospective cohort study included all adults in one Boston teaching hospital who underwent neurosurgery between 2000-2012, survived hospitalization and had a Physical Therapist functional status assessment within 48-hours of discharge. 90-day post-discharge all-cause mortality was obtained from the US Social Security Administration Death Master File. Logistic regression analysis was used. Results: 2,369 patients were included, comprising 65% cranial and 35% spinal. Malignancy and trauma was 47% and 13%, respectively. 238 patients had independent functional status. 90-day mortality and readmission was 8.3% and 28%, respectively. Second, third and lowest quartile of functional status was associated with a 3.16 (95%CI 1.08-9.24), 6.00 (2.11-17.04) and 6.26 (2.16-18.16) respective increased odds of 90-day post-discharge mortality compared to patients with independent functional status, adjusting for age, gender, race, length of stay, presence of malignancy and Deyo-Charlson comorbidity. Good discrimination (AUC 0.82) and calibration (Hosmer-Lemeshow χ2 P = 0.23) were demonstrated. Adjusted odds of 90-day readmission in patients with the lowest quartile of functional status was 1.89 (1.28-2.80) higher than patients with independent functional status. Conclusions: Lower functional status at hospital discharge following neurosurgery is associated with increased post-discharge mortality and hospital readmission.