Predictors of Discharge Disposition Following Laminectomy for Intradural Extramedullary Spinal Tumors

Abstract

To identify independent risk factors for non-home discharge in patients undergoing laminectomy for intradural extramedullary spinal tumors. We performed a retrospective cohort analysis of data from the American College of Surgeons National Surgical Quality Improvement Program from 2011 to 2014. Adult patients who underwent laminectomy for the excision of intradural extramedullary spinal tumors were included and divided into 2 groups based on home or non-home discharge disposition. We compared baseline patient characteristics, comorbidities, and operative factors between the 2 groups, and then performed multivariate regression analyses to identify independent risk factors for non-home discharge. A total of 1232 patients were included, of whom 248 (20.1%) were discharged to a non-home facility. Univariate analysis demonstrated that patients discharged to a non-home facility were more frequently aged ≥65 years and American Society of Anesthesiologists classification ≥3 with obesity, diabetes, dyspnea, functional dependence, cardiac comorbidity, renal comorbidity, and anemia. Operative factors correlated with non-home discharge were operative time of ≥4 hours and tumor location in the cervical or thoracic spine. Multivariate regression analysis identified age ≥65 years (odds ratio [OR] 2.73; confidence interval [CI] 1.80-4.13; P < 0.001), American Society of Anesthesiologists classification ≥3 (OR 2.36; CI 1.53-3.65; P < 0.001), dependent functional status (OR 4.30; CI 1.95-9.48; P < 0.001), hospital-acquired conditions (OR 2.32; CI 1.15-4.68; P= 0.019), and prolonged length of stay (OR 4.05; CI 2.72-6.03; P < 0.001) as predictors of non-home discharge. Early identification of patients at risk for non-home discharge is important in order to implement comprehensive discharge planning protocols that reduce inpatient length of stay, as well as associated complications and costs.