Risk factors for post-discharge complications and readmissions in home-discharges after elective posterior lumbar fusions
| Autor: | Azeem Tariq Malik, Safdar N. Khan, Romi Xi, Jeffery Kim, Jack Xie, Elizabeth Yu |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Reoperation medicine.medical_specialty Multivariate analysis Post discharge Patient Readmission 03 medical and health sciences 0302 clinical medicine Lumbar Postoperative Complications Sex Factors Risk Factors Internal medicine Diabetes mellitus Surgical Wound Dehiscence Diabetes Mellitus Medicine Humans Hypoglycemic Agents Insulin Surgical Wound Infection In patient Obesity Adverse effect Glucocorticoids Aged Venous Thrombosis Lumbar Vertebrae business.industry General Medicine Blood Coagulation Disorders Length of Stay Middle Aged medicine.disease Patient Discharge Spinal Fusion Elective Surgical Procedures 030220 oncology & carcinogenesis Hypertension Multivariate Analysis Operative time Surgery Female Neurology (clinical) Complication business 030217 neurology & neurosurgery |
| Zdroj: | Clinical neurology and neurosurgery. 185 |
| ISSN: | 1872-6968 |
| Popis: | Objectives Previous literature has studied overall post-operative outcomes following lumbar fusions. We examined the rates and risk factors for adverse outcomes in patients who are being discharged home. Patients and methods The 2012–2016 ACS-NSQIP database was used to query for patients undergoing 1- to 2-level posterior lumbar fusions (PLFs) for degenerative spinal pathology. Patients discharged to a destination other than home were removed from the database. Results Out of a total of 19,179 home-discharge patients, 546 (2.8%) experienced any adverse event (AAE), 276 experienced a severe adverse event (SAE) and 321 (1.7%) experienced a minor adverse event (MAE). Overall re-admission and re-operation rate in home-discharged patients was 4.4% and 2.5%. Multivariate analysis identified the following predictors for experiencing an AAE – Bleeding disorder (OR 2.25), BMI ≥ 35.0 vs. BMI 3 days (OR 1.53), insulin-dependent diabetes mellitus (OR 1.44), hypertension (OR 1.28) and female gender (OR 1.24). Patients with a pre-discharge complication (OR 2.12), bleeding disorders (OR 1.84), chronic steroid use (OR 1.55), age>75 (OR 1.49), age>65 (OR 1.26), history of severe COPD (OR 1.43), total operative time >210 min. (OR 1.26), ASA > II (OR 1.26) and undergoing a 2-level fusion (OR 1.21) were likely to be re-admitted from home. Conclusions Providers should utilize the data to risk-stratify and better understand the need of provision of supplemental health-care services, in home-discharged patients, and/or regular clinic follow-up to minimize the rate of adverse events and reduce costs in a bundled-payment environment. |
| Databáze: | OpenAIRE |
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