The risk factors influencing nonroutine discharge in surgical patients with spinal metastases: a scoping review

Nonroutine discharge is associated with increased healthcare costs and higher readmission rates among surgical patients with spinal metastases. However, the factors influencing nonroutine discharge remain inadequately summarized, and related research is still in its early stages. This review aims to identify and analyze the risk factors associated with nonroutine discharge in these patients, with the goal of informing discharge planning.

A scoping review was conducted following the framework established by Arksey and O'Malley. We systematically searched PubMed, Web of Science, and CINAHL for studies examining risk factors influencing nonroutine discharge in surgical patients with spinal metastases. Data extraction was performed independently by two researchers, with discrepancies resolved by a third reviewer.

Nine studies were included, which identified a range of factors influencing nonroutine discharge. These factors were categorized into three main domains: (1) sociodemographic factors (age, race, insurance status, marital status, and family member involvement), (2) disease-related factors (spinal cord injury grade, serum albumin level, body mass index, spinal surgery segment, type of surgery, preoperative functional dependency, ASA grade, emergency versus elective surgery, and activities of daily living at discharge), and (3) other factors (frailty index, comorbidity index, and the efficiency of the referral or discharge process).

The risk of nonroutine discharge in surgical patients with spinal metastases is influenced by sociodemographic, disease-related, and other factors. Early identification of patients at risk for nonroutine discharge is crucial for implementing a comprehensive, nurse-led discharge plan aimed at reducing hospital stay duration and minimizing related complications.