Predictive Risk Factors of Nonhome Discharge Following Elective Posterior Cervical Fusion

Abstract

To identify risk factors that are predictive of nonhome discharge after elective posterior cervical fusion. We performed a retrospective cohort study of adult patients who underwent elective posterior cervical fusion using the American College of Surgeons National Surgical Quality Improvement Program database from 2010 to 2014. Patients were divided into 2 groups: home discharge and nonhome discharge. Univariate analysis was performed to compare incidence of 30-day postoperative complications between groups. Multivariate analysis was performed to identify complications that were predictive of nonhome discharge. The cohort included 2875 patients; 24.1% were discharged to a nonhome facility, including skilled and nonskilled care facilities, nursing homes, assisted living facilities, and rehabilitation facilities. Nonhome discharge was associated with higher rates of 30-day pulmonary complication, cardiac complication, venous thromboembolism, urinary tract infection, blood transfusion, sepsis, and reoperation. Significant predictors of nonhome discharge were wound complication (odds ratio [OR]= 1.73; 95% confidence interval [CI], 1.07-2.80; P= 0.024), pulmonary complication (OR= 3.61; 95% CI, 1.96-6.63; P<0.001), cardiac complication (OR= 6.13; 95% CI, 1.61-23.4; P= 0.008), venous thromboembolism (OR= 2.97; 95% CI, 1.43-6.19; P=0.004), urinary tract infection (OR= 2.69; 95% CI, 1.50-4.82; P < 0.001), blood transfusion (OR= 1.70; 95% CI, 1.20-2.39; P= 0.003), sepsis (OR= 2.75; 95% CI, 1.25-6.02; P= 0.012), and prolonged length of stay (OR= 4.07; 95% CI, 3.34-4.95; P < 0.001). Early identification of patients who are at high risk for nonhome discharge is important to implement early comprehensive discharge planning protocols and minimize hospital-acquired conditions related to prolonged length of stay and associated health care costs.