Discharge Disposition after Anterior Cervical Discectomy and Fusion

OBJECTIVE:

Age and comorbidity burden of anterior cervical discectomy and fusion (ACDF) patients have increased significantly over the past two decades, resulting in increased expenditures. Non-home discharge after ACDF contributes to increased direct and indirect costs of postoperative care. The purpose of this study was to identify independent prognostic factors for discharge disposition in patients undergoing ACDF METHODS: A retrospective review was conducted at five medical centers to identify patients undergoing ACDF for degenerative conditions. The primary outcome was non-home discharge. Additional outcomes considered included discharge to rehabilitation and home discharge with services. Bivariate and multivariable analyses were used to identify independent prognostic factors for non-home discharge.

RESULTS:

Of 2070 patients undergoing ACDF, 114 (5.5%) had non-home discharge and 63 (3.0%) had discharge to inpatient rehabilitation. Factors independently associated with non-home discharge included: older age, marital status, Medicare insurance, Medicaid insurance, previous spine surgery, myelopathy, preoperative comorbidities (hemiplegia/paraplegia, congestive heart failure, cerebrovascular accident), anemia, and leukocytosis. C-statistic for the overall model was 0.85. Results were relatively similar for patients under the age of sixty-five as well as for discharge to inpatient rehabilitation and discharge home with services.

CONCLUSION:

Numerous sociodemographic and clinical characteristics influence the risk of non-home discharge and discharge to inpatient rehabilitation in patients undergoing ACDF. Policy makers and payers should consider these factors when determining appropriate pre-operative adjustment for risk-based reimbursements.

 2019 Sep 12. pii: S1878-8750(19)32456-8. doi: 10.1016/j.wneu.2019.09.026. [Epub ahead of print]