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Home Versus Rehabilitation: Factors that Influence Disposition After Minimally Invasive Surgery in Adult Spinal Deformity Surgery
- Source :
- World neurosurgery. 118
- Publication Year :
- 2018
-
Abstract
- Minimally invasive surgery (MIS) correction for adult spinal deformity (ASD) may reduce the need the need for postoperative skilled nursing facility (SNF) or inpatient rehabilitation (IR) placement following surgery. The likelihood of requiring placement in a facility rather than home disposition may be influenced by various factors. In addition, the associations between discharge location and outcomes and complication rates have not been elucidated in these patients. In this study, we aimed to define factors predicting disposition to an SNF/IR and to elucidate the rates of complications occurring in patients sent to home versus to a facility.A retrospective review of a multicenter ASD database, which included patients who underwent surgery between 2009 and 2014. Inclusion criteria were age18 years, MIS as part of index surgery, location of discharge, and at least 1 of the following: pelvic tilt20°, sagittal vertical axis5 cm, pelvic incidence-lumbar lordosis mismatch10, or lumbar scoliosis20°. Patients with a 2-year follow-up were included. Preoperative demographic and radiographic data, postoperative (30 day) complications, and health-related quality of life were analyzed.A total of 182 patients met our inclusion criteria, including 113 who were discharged to home and 69 who were discharged to an SNF/IR. Older patients (50 years) were more likely to be discharged to an SNF/IR (P = 0.043). Those aged70 years were 6-fold more likely to go to an SNF/IR. No association was identified between discharge to an SNF/IR and any radiographic parameters except preoperative pelvic tilt (odds ratio [OR], 1.11; P = 0.009). Staged cases were more likely to be discharged to an SNF/IR (OR, 3.24; 95% confidence interval, 1.11-9.46; P = 0.032); otherwise, there was no difference in levels treated, operating time, estimated blood loss, osteotomy, or length of hospital stay. Patients requiring discharge to an SNF/IR had a higher rate of complications (58% vs. 39.8%; P = 0.017), including major complications (19.5% vs. 42%; P = 0.001), perioperative complications (14.2% vs. 31.9%; P = 0.004) and infections (3.5% vs. 13%; P = 0.016). Patients discharged to an SNF/IR had a higher rate of revision (19.5% vs. 33%; P = 0.035). Health-related quality of life measures were similar regardless of disposition.Older patients and those undergoing staged MIS deformity correction have a higher likelihood of postoperative disposition to an SNF/IR. Complications occurred more commonly in those patients requiring transfer to an SNF/IR after hospitalization.
- Subjects :
- Pelvic tilt
Adult
Male
Reoperation
medicine.medical_specialty
medicine.medical_treatment
Scoliosis
Rehabilitation Centers
03 medical and health sciences
0302 clinical medicine
Quality of life
medicine
Humans
Minimally Invasive Surgical Procedures
Aged
Retrospective Studies
Postoperative Care
030222 orthopedics
Rehabilitation
business.industry
Retrospective cohort study
Odds ratio
Perioperative
Middle Aged
medicine.disease
Home Care Services
Surgery
Treatment Outcome
Female
Neurology (clinical)
Complication
business
030217 neurology & neurosurgery
Follow-Up Studies
Subjects
Details
- ISSN :
- 18788769
- Volume :
- 118
- Database :
- OpenAIRE
- Journal :
- World neurosurgery
- Accession number :
- edsair.doi.dedup.....a0bb62f6ea3ceb681ff84b812a8ec296