Drivers for nonhome discharge in a consecutive series of 1502 patients undergoing 1- or 2-level lumbar fusion
| Autor: | Christy L. Daniels, Portia Steele, John R. Dimar, Yoji Ogura, Leah Y. Carreon, Jeffrey L. Gum, Joseph L. Laratta, Mladen Djurasovic, Morgan Brown, R. Kirk Owens, Charles H. Crawford, Steven D. Glassman |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
business.industry Medical record General Medicine Logistic regression 03 medical and health sciences 0302 clinical medicine Lumbar 030220 oncology & carcinogenesis Health care Emergency medicine medicine Marital status Residence business Body mass index 030217 neurology & neurosurgery Reimbursement |
| Zdroj: | Journal of Neurosurgery: Spine. 33:766-771 |
| ISSN: | 1547-5654 |
| Popis: | OBJECTIVEUnexpected nonhome discharge causes additional costs in the current reimbursement models, especially to the payor. Nonhome discharge is also related to longer length of hospital stay and therefore higher healthcare costs to society. With increasing demand for spine surgery, it is important to minimize costs by streamlining discharges and reducing length of hospital stay. Identifying factors associated with nonhome discharge can be useful for early intervention for discharge planning. The authors aimed to identify the drivers of nonhome discharge in patients undergoing 1- or 2-level instrumented lumbar fusion.METHODSThe electronic medical records from a single-center hospital administrative database were analyzed for consecutive patients who underwent 1- to 2-level instrumented lumbar fusion for degenerative lumbar conditions during the period from 2016 to 2018. Discharge disposition was determined as home or nonhome. A logistic regression analysis was used to determine associations between nonhome discharge and age, sex, body mass index (BMI), race, American Society of Anesthesiologists grade, smoking status, marital status, insurance type, residence in an underserved zip code, and operative factors.RESULTSA total of 1502 patients were included. The majority (81%) were discharged home. Factors associated with a nonhome discharge were older age, higher BMI, living in an underserved zip code, not being married, being on government insurance, and having more levels fused. Patients discharged to a nonhome facility had longer lengths of hospital stay (5.6 vs 3.0 days, p < 0.001) and significantly increased hospital costs ($21,204 vs $17,518, p < 0.001).CONCLUSIONSIncreased age, greater BMI, residence in an underserved zip code, not being married, and government insurance are drivers for discharge to a nonhome facility after a 1- to 2-level instrumented lumbar fusion. Early identification and intervention for these patients, even before admission, may decrease the length of hospital stay and medical costs. |
| Databáze: | OpenAIRE |
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