BACKGROUND CONTEXT Spinal fusion is becoming a candidate for bundled payment; understanding the risk factors for nonhome discharge, postdischarge adverse events (AE), and unplanned readmissions is key in making this system viable. This analysis focuses on the risk factors for these outcomes for patients undergoing posterior cervical decompression and fusion (PCDF), a surgical population especially at risk for AEs and readmission relative to other fusion procedures. PURPOSE To understand the risk factors for nonhome discharge, severe postdischarge AE, and unplanned readmission for patients undergoing PCDF. STUDY DESIGN/SETTING All patients undergoing PCDF between 2012 and 2015 were queried from the National Surgical Quality Improvement Project (NSQIP) database. Patients were identified using the current procedural terminology (CPT) codes 63,045, 63,001, 63,015, 22,210, 22,110 and 22,600. Patients undergoing anterior cervical fusion in the same hospital stay were excluded. PATIENT SAMPLE Over a 4-year period, a total of 8,743 patients underwent PCDF in the NSQIP database. OUTCOME MEASURES Outcomes included nonhome discharge, unplanned 30-day readmission, and severe postdischarge AE (deep wound infection, organ or space infection, wound dehiscence, reintubation, DVT, PE, weaning failure, renal insufficiency, renal failure, CVA, cardiac arrest, MI, sepsis, septic shock, reoperation and death). METHODS Demographic variables and comorbidity status were analyzed using bivariate analysis. Step-wise multiple logistic regression using backward elimination (p=.2) was utilized to analyze the outcomes stated above. Models included the following variables: nonhome discharge, severe predischarge AE, age, operative time, sex, functional status, BMI>40, diabetic status, length of stay, ASA status >2, and history of pulmonary disease, heart disease, hypertension requiring medication, stroke, renal failure or bleeding disorder. RESULTS Patients with nonhome discharges were significantly older (67.4 vs. 58.6 years, p CONCLUSIONS PCDF patients who are discharged home have a higher likelihood of having a severe adverse event postdischarge and having an unplanned readmission. As LOS remains a common target for cost reduction, it is important to note that it may not be worth sacrificing home discharge for decreased LOS, as these patients will be predisposed to adverse events and return to the hospital.