PMID- 32101991
OWN - NLM
STAT- MEDLINE
DCOM- 20211025
LR  - 20211025
IS  - 2380-0194 (Electronic)
IS  - 2380-0186 (Linking)
VI  - 33
IP  - 10
DP  - 2020 Dec
TI  - Nonhome Discharge as an Independent Risk Factor for Adverse Events and 
      Readmission in Patients Undergoing Anterior Cervical Discectomy and Fusion.
PG  - E454-E459
LID - 10.1097/BSD.0000000000000961 [doi]
AB  - STUDY DESIGN: A retrospective study of a prospectively collected cohort. 
      OBJECTIVE: To characterize a cohort of patients who underwent anterior cervical 
      discectomy and fusion (ACDF) and examine whether nonhome discharge (NHD) is 
      associated with postdischarge adverse events (AEs) and readmission. SUMMARY OF 
      THE BACKGROUND DATA: Predictors of NHD have been elucidated in the spine surgery 
      literature, and NHD has been tied to poor outcomes in the joint arthroplasty 
      literature, but no such analysis exists for patients undergoing ACDF. MATERIALS 
      AND METHODS: All patients who underwent ACDF from 2012 to 2015 in the National 
      Surgical Quality Improvement Program were identified. Those who underwent 
      concomitant posterior cervical operations were excluded. Patients who were 
      discharged to home were compared with those discharged to nonhome destinations on 
      the basis of demographics and outcomes. Multivariable models were created to 
      assess whether NHD was an independent risk factor for postdischarge AEs and 
      readmission. RESULTS: NHD patients were significantly older (63.96 vs. 53.57 y; 
      P<0.0001), more functionally dependent (13.87% vs. 1.09%; P<0.0001), more likely 
      to have body mass index >40 (9.38% vs. 7.51%; P=0.004), and more likely to have 
      ASA Class >2 (77.89% vs. 39.57%; P<0.0001). Patients who underwent NHD were 
      significantly more likely to suffer severe AEs (14.44% vs. 0.93%; P<0.0001), 
      minor AEs (7.22% vs. 0.24%; P<0.0001), and infectious complications (3.58% vs. 
      0.13%; P<0.0001) before discharge. When examining AEs after discharge, patients 
      who underwent NHD were more likely to suffer severe AEs (6.37% vs. 1.34%; 
      P<0.0001), minor AEs (4.09% vs. 0.74%; P<0.0001), death (1.25% vs. 0.07%; 
      P<0.0001), and unplanned readmission (10.12% vs. 3.06%; P<0.0001). In adjusted 
      analysis, NHD was found to independently predict severe AEs after discharge (odds 
      ratio, 2.40; 95% confidence interval, 1.87-3.07; P<0.0001) and readmission (odds 
      ratio, 1.77; 95% confidence interval, 1.46-2.14; P<0.0001). CONCLUSIONS: NHD 
      patients were significantly sicker than those discharged home. In addition, NHD 
      is associated with higher rates of postdischarge complications.
FAU - Neifert, Sean Nakatani
AU  - Neifert SN
AD  - Departments of Neurosurgery.
FAU - Gal, Jonathan S
AU  - Gal JS
AD  - Anesthesiology, Perioperative, and Pain Medicine.
FAU - Chapman, Emily K
AU  - Chapman EK
AD  - Departments of Neurosurgery.
FAU - Caridi, John M
AU  - Caridi JM
AD  - Departments of Neurosurgery.
AD  - Orthopedics, Mount Sinai Hospital, New York, NY.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Clin Spine Surg
JT  - Clinical spine surgery
JID - 101675083
SB  - IM
MH  - Aftercare
MH  - Cervical Vertebrae/surgery
MH  - Diskectomy/adverse effects
MH  - Humans
MH  - *Patient Discharge
MH  - Patient Readmission
MH  - Postoperative Complications/etiology
MH  - Retrospective Studies
MH  - Risk Factors
MH  - *Spinal Fusion/adverse effects
EDAT- 2020/02/27 06:00
MHDA- 2021/10/26 06:00
CRDT- 2020/02/27 06:00
PHST- 2020/02/27 06:00 [pubmed]
PHST- 2021/10/26 06:00 [medline]
PHST- 2020/02/27 06:00 [entrez]
AID - 01933606-202012000-00009 [pii]
AID - 10.1097/BSD.0000000000000961 [doi]
PST - ppublish
SO  - Clin Spine Surg. 2020 Dec;33(10):E454-E459. doi: 10.1097/BSD.0000000000000961.