Identifying patients at risk for a facility discharge following elective one or two level lumbar fusion

Spine procedures are becoming increasingly common and costly in the United States, thus managing fiscal responsibility with surgical outcomes is increasingly important. Reducing facility discharges following a lumbar fusion would not only reduce complications but could provide significant cost savings. Therefore, the purpose of this study is to identify both clinical factors (i.e. demographics, medical history factors) and patient reported outcome scores that were associated with an increased risk of a facility-based discharge following an elective 1 or 2 level lumbar fusion.

A total of 513 patients that underwent a 1- or 2-level lumbar fusion between June 2021 and June 2023 were included in this retrospective study. All patients completed their preoperative PROs and completed their medical history and physical prior to surgery. Using logistic regressions, independent variables associated with postoperative discharge to a skilled nursing facility were identified. Subsequent receiver operator curve analysis helped determine cut point values associated with a facility discharge.

A total of 41 patients (7.9%) were discharged to a facility. Regression analysis identified 6 factors associated with a facility discharge. Three factors were related to clinical outcomes while the other 3 factors were obtained from patient reported outcomes measures. More specifically, PROMIS-10 Global physical (OR:0.17,95% CI 0.04-0.62, AUC:0.701) and mental health (OR:0.89,95% CI 0.83-0.95, AUC:0.813) T-scores below 40, and RAPT scores below 9 (OR:0.60,95% CI 0.48-0.74, AUC:0.814) were associated with facility-based discharges.

Patient reported outcomes measures provide significant discriminatory ability in combination with standard clinical metrics to identify patients at risk for a facility discharge following elective lumbar fusions. The results suggested that patient reported information concerning preoperative mobility, mental wellbeing, and support at home were more discriminatory than clinical metrics.