Development of a Predictive Score for Discharge Disposition After Lumbar Fusion Using the Quality Outcomes Database.

Background: Lumbar fusion remains the treatment of choice for many degenerative pathologies. Healthcare costs related to the procedure are a concern, and postdischarge needs often contribute to greater expenditure. The Quality Outcomes Database (QOD) is a prospective, multicenter clinical registry designed to analyze outcomes after neurosurgical procedures.
Objective: To create a simple scoring system to predict discharge needs after lumbar fusion.
Methods: Institutional QOD data from 2 high-volume neurosurgical centers were collected retrospectively. Univariate and multivariable logistic regression analyses were used to identify factors for our model. A receiver operating characteristic curve was used to set cutoff scores for patients likely to discharge home without ongoing services and those likely to require additional services/alternative placement after discharge.
Results: Two hundred seventeen patients were included. Five variables-osteoporosis, predominant preoperative symptom, need for assistive ambulation device, American Society of Anesthesiologist grade, and age-were included in our final scoring system. Patients with higher scores are less likely to need additional services. In patients with high scores (8-10), our scale correctly predicted discharge needs in 88.7% of cases. In patients with low scores (0-5), our scale predicted discharge needs (additional home services/alternative placement) in 75% of cases. For our final instrument, the area under the receiver operating characteristic curve was 0.809 (95% confidence interval 0.720-0.897).
Conclusion: We present a simple scoring system to assist in predicting postdischarge needs for patients undergoing lumbar fusion for degenerative disease. Further validation studies are needed to assess the generalizability of our scale.