P147. The at-HOME score: A novel scoring system predicting discharge disposition following ASD surgery

Abstract

<h3>BACKGROUND CONTEXT</h3> Adult spinal deformity (ASD) surgery requires an extended postoperative recovery period and oftentimes non-routine discharge (DC). Predicting which patients will likely have non-home DC has both clinical and economic implications. <h3>PURPOSE</h3> The aim of this study was to develop and internally validate a novel and simple score-based risk stratification system (At-HOME Score) to preoperatively identify patients mostly likely to require non-home DC. <h3>STUDY DESIGN/SETTING</h3> Retrospective review of a single-center surgical registry. <h3>PATIENT SAMPLE</h3> A total of 195 adult thoracolumbar deformity patients. <h3>OUTCOME MEASURES</h3> Home vs non-home DC. <h3>METHODS</h3> In total, the study cohort included 195 adult thoracolumbar deformity patients who underwent spine fusion ≥ 5 levels from 2006-2018. We split this cohort 50% for training the model and 50% for the validating the model. Data collected included patient demographics, comorbidities, surgical parameters, ODI, SRS, Charlson Comorbidity Index (CCI), and 30-day postoperative complications. We performed multivariable logistic regression on the training set to identify preoperative risk factors for non-home DC. The risk factors were weighted based on nomogram analysis and aggregated into the 11-point At-HOME model. Using area under curve (AUC) analysis, we internally validated the At-HOME score by applying it to the validation set with comparison to CCI. Optimal cutoffs for the scoring system were determined using stratum-specific likelihood ratio (SSLR) analysis. <h3>RESULTS</h3> Mean age at index surgery was 60 ± 13 years, 77% females. 45% (88) had a non-home DC. Points in the At-HOME Score were assigned as follows: +1 for preoperative SRS Activity domain < 3 (OR=2.4), +1 for Hypothyroidism, (OR=2.8), +2 for preoperative ODI ≥ 42 (OR=2.7), +3 for preoperative Motor weakness (OR=2.8), +4 for Elderly age > 65 years (OR=5.6) (p<0.05 for all). The At-HOME Score had an AUC of 0.81 in both the training and validation set, which was significantly higher than the AUC of CCI (p<0.001). SSLR analysis produced 4 distinct categories based on risk of non-home DC: 4% for score 0, 31% for score 1-5, 65% for score 6-7, 86% for score 8+. Relative to a score of 0, scores of 1-5, 6-7, and 8+ had 11x, 46x, and 150x greater odds of non-home DC (p<0.05 for all). <h3>CONCLUSIONS</h3> By using a robust combination of baseline demographics, objective clinical criteria, and patient reported outcomes, the At-HOME score was highly predictive of non-routine DC following ASD surgery. This tool was shown to be more predictive than CCI. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.