TY - JOUR
T1 - Indicators for nonroutine discharge following cervical deformity-corrective surgery
T2 - Radiographic, surgical, and patient-related factors
AU - Bortz, Cole A.
AU - Passias, Peter G.
AU - Segreto, Frank
AU - Horn, Samantha R.
AU - Lafage, Virginie
AU - Smith, Justin S.
AU - Line, Breton
AU - Mundis, Gregory M.
AU - Kebaish, Khaled M.
AU - Kelly, Michael P.
AU - Protopsaltis, Themistocles
AU - Sciubba, Daniel M.
AU - Soroceanu, Alexandra
AU - Klineberg, Eric O.
AU - Burton, Douglas C.
AU - Hart, Robert A.
AU - Schwab, Frank J.
AU - Bess, Shay
AU - Shaffrey, Christopher I.
AU - Ames, Christopher P.
N1 - Funding Information:
The International Spine Study Group (ISSG) is funded through research grants from DePuy Synthes and individual donations. Dr Passias is a consultant for Medicrea and Spinewave, is on the Scientific Advisory Board for Allosource, is a teacher/speaker for Zimmer Biomet and Globus, has a grant from CSRS, and is involved in a research study for Aesculap. Dr Lafage has stock ownership in and is on the Board of Directors for Nemaris, is a teacher/speaker for DePuy Synthes, Nuvasive, K2M, and Medtronic. Dr Smith receives royalties from Zimmer Biomet, is a consultant for Zimmer Biomet, Nuvasive, and Cerapedics, is a teacher/speaker for Zimmer Biomet, Nuvasive, and K2M, and receives fellowship support from AOSpine and NREF. Dr Mundis Jr receives royalties from K2M and is a consultant for K2M, DePuy Synthes, and Nuvasive. Dr Kelly receives research support from DePuy Synthes, Oref, CSRS, AOSpine, the Fox Family Foundation, and the Barnes Jewish Foundation. Dr Protopsaltis is a consultant for Globus, Medicrea, and Innovasis, and receives research support from Zimmer Biomet. Dr Sciubba is a consultant for Medtronic and has stock ownership in DePuy Synthes, Stryker, K2M, and NuVasive. Dr Klineberg is a consultant for DePuy Synthes, Stryker, Springer, and Trevana, receives honoraria from AOSpine and K2M, and has fellowship support from AOSpine. Dr Burton is a consultant for DePuy Synthes and Allosource and is a patent holder with DePuy Synthes. Dr Hart is a consultant for DePuy Synthes, Globus, and Medtronic, is a teacher/speaker for DePuy Synthes, receives research support from Medtronic, and has other financial support from Seaspine. Dr Schwab is a speaker/teacher, consultant, and has royalties/patents with Zimmer Biomet, NuVasvie, K2M, MSD, is a teacher/speaker and consultant for Medicrea, and is a shareholder and on the Board of Directors for Nemaris. Dr Bess is a consultant for K2M and AlloSource, receives royalties from Pionee, Innovasis, K2M, Nuvasive, and DePuy Synthes Spine, and receives research support from K2M, Innovasis, Nuvasive, DePuy Synthes Spine, and Stryker. Dr Shaffrey receives royalties from, holds patents with, and consults for Medtronic, Nuvasive, and Zimmer Biomet, is a stock holder in Nuvasive, is a consultant for K2M, Stryker, and InVivo, and has grants from NIG, the Department of Defense, ISSG, DePuy Synthes, and AOSPine. Dr Ames is a consultant for DePuy Synthes, Medtronic, and Stryker, has royalties from Stryker and Zimmer Biomet, and holds patents with Fish & Richardson, PC.
Publisher Copyright:
© Copyright 2019 by the Congress of Neurological Surgeons.
PY - 2019/9/1
Y1 - 2019/9/1
N2 - BACKGROUND: Nonroutine discharge, including discharge to inpatient rehab and skilled nursing facilities, is associated with increased cost-of-care. Given the rising prevalence of cervical deformity (CD)-corrective surgery and the necessity of value-based healthcare, it is important to identify indicators for nonroutine discharge. OBJECTIVE: To identify factors associated with nonroutine discharge after CD-corrective surgery using a statistical learning algorithm. METHODS: A retrospective review of patients ≥18 yr with discharge and baseline (BL) radiographic data. Conditional inference decision trees identified factors associated with nonroutine discharge and cut-off points at which factors were significantly associated with discharge status. A conditional variable importance table used nonreplacement sampling set of 10 000 conditional inference trees to identify influential patient/surgical factors. The binary logistic regression indicated odds of nonroutine discharge for patients with influential factors at significant cut-off points. RESULTS: Of 138 patients (61 yr, 63% female) undergoing surgery for CD (8 ± 5 levels; 49% posterior approach, 16% anterior, and 35% combined), 29% experienced nonroutine discharge. BL cervical/upper-cervical malalignment showed the strongest relationship with nonroutine discharge: C1 slope ≥ 14°, C2 slope ≥ 57°, TS-CL ≥ 57°. Patient-related factors associated with nonroutine discharge included BL gait impairment, age ≥ 59 yr and apex of CD primary driver ≥ C7. The only surgical factor associated with nonroutine discharge was fusion ≥ 8 levels. There was no relationship between nonhome discharge and reoperation within 6 mo or 1 yr (both P >. 05) of index procedure. Despite no differences in BL EQ-5D (P =. 946), nonroutine discharge patients had inferior 1-yr postoperative EQ-5D scores (P =. 044). CONCLUSION: Severe preoperative cervical malalignment was strongly associated with nonroutine discharge following CD-corrective surgery. Age, deformity driver, and ≥ 8 level fusions were also associated with nonroutine discharge and should be taken into account to improve patient counseling and health care resource allocation.
AB - BACKGROUND: Nonroutine discharge, including discharge to inpatient rehab and skilled nursing facilities, is associated with increased cost-of-care. Given the rising prevalence of cervical deformity (CD)-corrective surgery and the necessity of value-based healthcare, it is important to identify indicators for nonroutine discharge. OBJECTIVE: To identify factors associated with nonroutine discharge after CD-corrective surgery using a statistical learning algorithm. METHODS: A retrospective review of patients ≥18 yr with discharge and baseline (BL) radiographic data. Conditional inference decision trees identified factors associated with nonroutine discharge and cut-off points at which factors were significantly associated with discharge status. A conditional variable importance table used nonreplacement sampling set of 10 000 conditional inference trees to identify influential patient/surgical factors. The binary logistic regression indicated odds of nonroutine discharge for patients with influential factors at significant cut-off points. RESULTS: Of 138 patients (61 yr, 63% female) undergoing surgery for CD (8 ± 5 levels; 49% posterior approach, 16% anterior, and 35% combined), 29% experienced nonroutine discharge. BL cervical/upper-cervical malalignment showed the strongest relationship with nonroutine discharge: C1 slope ≥ 14°, C2 slope ≥ 57°, TS-CL ≥ 57°. Patient-related factors associated with nonroutine discharge included BL gait impairment, age ≥ 59 yr and apex of CD primary driver ≥ C7. The only surgical factor associated with nonroutine discharge was fusion ≥ 8 levels. There was no relationship between nonhome discharge and reoperation within 6 mo or 1 yr (both P >. 05) of index procedure. Despite no differences in BL EQ-5D (P =. 946), nonroutine discharge patients had inferior 1-yr postoperative EQ-5D scores (P =. 044). CONCLUSION: Severe preoperative cervical malalignment was strongly associated with nonroutine discharge following CD-corrective surgery. Age, deformity driver, and ≥ 8 level fusions were also associated with nonroutine discharge and should be taken into account to improve patient counseling and health care resource allocation.
KW - CD
KW - Cervical deformity
KW - Discharge
KW - Outcomes
KW - Rehabilitation
KW - Skilled nursing facility
KW - Surgery
UR - http://www.scopus.com/inward/record.url?scp=85071582361&partnerID=8YFLogxK
U2 - 10.1093/neuros/nyz016
DO - 10.1093/neuros/nyz016
M3 - Article
C2 - 30848284
AN - SCOPUS:85071582361
SN - 0148-396X
VL - 85
SP - E509-E519
JO - Clinical Neurosurgery
JF - Clinical Neurosurgery
IS - 3
M1 - nyz016
ER -