Risk Factors for Nonroutine Discharge in Patients Undergoing Spinal Fusion for Intervertebral Disc Disorders.

BACKGROUND

Although outcomes following spinal fusion for intervertebral disc disorders have been studied, factors influencing discharge disposition and health care resource utilization have not been determined. This study sought to clarify perioperative risk factors for non-routine discharge and prolonged hospital stay in patients undergoing fusion for intervertebral disc disorders.

METHODS

The National Hospital Discharge Survey was queried to identify all patients discharged from U.S. hospitals following spinal fusion for intervertebral disc disorders between 1990 and 2007. A cohort representative of 1,943,707 patients was identified and separated into those who were discharged home and those who were discharged to rehabilitation facilities. Multivariable logistic regression analysis was used to identify independent predictors of non-routine discharge to another inpatient facility and prolonged hospital stay.

RESULTS

The strongest risk factors for non-routine discharge were age>65 years, congestive heart failure, atrial fibrillation, any general in-hospital complication, diabetes mellitus, osteoporosis, hypertension and any surgery-related complication. Patients younger than 50 years and males had the lowest rate of non-routine discharge. The strongest risk factors for prolonged hospital stay were any surgery-related complication, congestive heart failure, any general in-hospital complication, atrial fibrillation, age > 65 years, osteoporosis and diabetes mellitus. Patients 36-50 years of age had the lowest risk of increased length of hospital stay.

CONCLUSIONS

Knowledge of these risk factors may aid in better resource allocation and improved strategies for managing patients with spondylosis in order to decrease healthcare costs.

LEVEL OF EVIDENCE: 3.