Home Versus Rehabilitation: Factors that Influence Disposition After Minimally Invasive Surgery in Adult Spinal...

Area of Science:

• Spine Surgery
• Orthopedics
• Minimally Invasive Procedures

Background:

• Minimally invasive surgery (MIS) for adult spinal deformity (ASD) aims to reduce the need for postoperative skilled nursing facility (SNF) or inpatient rehabilitation (IR) placement.
• Factors influencing discharge disposition (home vs. facility) and associated outcomes in ASD patients undergoing MIS are not well understood.
• This study investigates predictors of SNF/IR disposition and complication rates in ASD patients treated with MIS.

Purpose of the Study:

• To identify factors predicting postoperative disposition to an SNF/IR after MIS for ASD.
• To compare complication rates between patients discharged home and those discharged to an SNF/IR.

Main Methods:

• Retrospective review of a multicenter ASD database (2009-2014).
• Inclusion criteria: age >18, MIS as part of index surgery, specific radiographic parameters (pelvic tilt, sagittal vertical axis, pelvic incidence-lumbar lordosis mismatch, lumbar scoliosis), and 2-year follow-up.
• Analysis of preoperative demographics, radiographic data, postoperative complications (<30 days), and health-related quality of life.

Main Results:

• Older patients (>50 years, especially >70 years) were more likely to be discharged to an SNF/IR.
• Staged MIS procedures and higher preoperative pelvic tilt were associated with SNF/IR disposition.
• Patients discharged to SNF/IR had significantly higher rates of overall complications, major complications, perioperative complications, and infections compared to those discharged home.

Conclusions:

• Advanced age and staged MIS correction for ASD increase the likelihood of postoperative SNF/IR disposition.
• Patients requiring SNF/IR placement after MIS for ASD experience a higher incidence of postoperative complications.
• Health-related quality of life outcomes were similar between home and facility discharges.