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Predictors of successful early discharge in revision lumbar fusion
Omar H Tarawneh1, Rajkishen Narayanan1, Jonathan Dalton1
1Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, 925 Chestnut Street, 5th floor, Philadelphia, PA 19107, USA.
Background Context:
Reducing length of hospital stay (LOS) and establishing earlier discharge goals are critically important in terms of improving patient satisfaction and maximizing value in spine surgery. Revision lumbar fusion is associated with higher costs and longer inpatient stays compared to primary surgery. Identifying factors that correlate with safe early discharge in this population can inform efforts to improve the value of care.
Purpose:
This study aims to evaluate predictors of successful early discharge following revision lumbar fusion.
Study Design/Setting:
Retrospective cohort.
Patient Sample:
Patients who underwent 1 to 2 level revision lumbar fusion from 2011 to 2022 were included.
Outcome Measures:
Emergency department (ED) visits within 30 days postoperatively and readmissions within 30- and 90-days were recorded. Subanalyses of patient-reported outcome measures (PROMs) and postoperative opioid use were performed.
Methods:
Patients were stratified as early and late discharge, with those in the lowest 25% of LOS classified as achieving early discharge. Early and late discharge groups were compared for outcome measures on bivariate and multivariate analyses.
Results:
Of the 479 patients included, 150 were in the early discharge group (LOS 1.85 vs 4.37 days, p<.001). Male sex was an independent predictor of early discharge (OR: 1.82, p=.010), while higher BMI (OR=0.95, p=.010), index procedure being a fusion (OR: 0.57, p=.022), nonunion (OR=0.27, p=.014) as the revision indication, and increased surgical duration (OR: 0.995, p=.019) demonstrated decreased odds of early discharge. Early discharge patients experienced greater VAS-back (-4.04 vs -2.58, p=.031), and VAS-leg (-4.32 vs -2.14, p=.008) improvement at 90 days. ED visits (7.33% vs 3.34%, p=.080) and 90-day readmissions (4.00% vs 5.17%, p=.746) were similar between groups.
Conclusions:
Elevated BMI, fusion as the index procedure, revisions due to nonunion, and longer operative time independently reduced the likelihood of early discharge. VAS scores for back and leg pain, were significantly better in the early DC group. No differences existed in postoperative ED visits or readmissions, highlighting the potential for safe, early discharges in the appropriately selected patient.
