Elsevier

World Neurosurgery

Volume 123, March 2019, Pages e427-e432
World Neurosurgery

Original Article
Predictors of Discharge Disposition Following Laminectomy for Intradural Extramedullary Spinal Tumors

https://doi.org/10.1016/j.wneu.2018.11.183Get rights and content

Objective

To identify independent risk factors for non-home discharge in patients undergoing laminectomy for intradural extramedullary spinal tumors.

Methods

We performed a retrospective cohort analysis of data from the American College of Surgeons National Surgical Quality Improvement Program from 2011 to 2014. Adult patients who underwent laminectomy for the excision of intradural extramedullary spinal tumors were included and divided into 2 groups based on home or non-home discharge disposition. We compared baseline patient characteristics, comorbidities, and operative factors between the 2 groups, and then performed multivariate regression analyses to identify independent risk factors for non-home discharge.

Results

A total of 1232 patients were included, of whom 248 (20.1%) were discharged to a non-home facility. Univariate analysis demonstrated that patients discharged to a non-home facility were more frequently aged ≥65 years and American Society of Anesthesiologists classification ≥3 with obesity, diabetes, dyspnea, functional dependence, cardiac comorbidity, renal comorbidity, and anemia. Operative factors correlated with non-home discharge were operative time of ≥4 hours and tumor location in the cervical or thoracic spine. Multivariate regression analysis identified age ≥65 years (odds ratio [OR] 2.73; confidence interval [CI] 1.80–4.13; P < 0.001), American Society of Anesthesiologists classification ≥3 (OR 2.36; CI 1.53–3.65; P < 0.001), dependent functional status (OR 4.30; CI 1.95–9.48; P < 0.001), hospital-acquired conditions (OR 2.32; CI 1.15–4.68; P = 0.019), and prolonged length of stay (OR 4.05; CI 2.72–6.03; P < 0.001) as predictors of non-home discharge.

Conclusions

Early identification of patients at risk for non-home discharge is important in order to implement comprehensive discharge planning protocols that reduce inpatient length of stay, as well as associated complications and costs.

Introduction

Primary spinal tumors are rare, with an incidence of 0.76 per 100,000 in the United States.1 Intradural extramedullary (IDEM) spinal tumors, specifically, comprise 30% of adult spinal tumors and are frequently benign, with the most common histologic types being schwannoma (30%) and meningioma (25%).2, 3, 4, 5, 6, 7, 8, 9 Although these tumors are rare, their management is highly complex.10, 11, 12 In patients with neurological deficits due to spinal cord compression from the tumor, surgical decompression and tumor resection are the standard of care, and have been shown to significantly improve quality of life and survival.5, 6, 7, 13

Patient discharge disposition after elective spine surgery is an important consideration for surgeons when considering clinical outcomes and health care costs.14 Early preoperative identification of patients at high risk for non-home discharge provides surgeons with the opportunity to implement comprehensive postoperative protocols that promote better allocation of resources and improved patient satisfaction.15 To the best of our knowledge, predictors of discharge disposition in patients who underwent decompression and excision of IDEM spinal tumors have not been studied. In this paper, we aim to retrospectively analyze the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to identify patient-related and surgery-related risk factors that predispose patients to non-home discharge after laminectomy for IDEM spinal tumors.

Section snippets

Data Source and Cohort Selection

This was a retrospective cohort study using data from 2011 to 2014 in the ACS-NSQIP database. ACS-NSQIP is a large national database with risk-adjusted 30-day postoperative morbidity and mortality outcomes. More than 500 hospitals varying in size, socioeconomic location, and academic affiliation contributed data. Dedicated clinical abstractors at each participating hospital prospectively collected data, including more than 150 demographic, preoperative, intraoperative, and 30-day postoperative

Study Population

A total of 1232 patients met the inclusion criteria for the study, of whom 984 (79.9%) were discharged home and 248 (20.1%) were discharged to a non-home facility (Table 1). Patients discharged to non-home facilities were more frequently aged ≥65 years (50.8% vs. 21.8%; P < 0.001), black or other race (7.3% vs. 5.0%; P = 0.002), had ASA classification ≥3 (69.4% vs. 41.1%; P < 0.001), obese (44.4% vs. 36.8%; P = 0.029), diabetic (16.1% vs. 8.1%; P < 0.001), had dyspnea (6.5% vs. 3.1%; P =

Discussion

In this retrospective analysis of the 2011–2014 ACS-NSQIP database, we found that in patients who underwent excisional laminectomy for the resection of IDEM spinal tumors, discharge to a non-home facility was associated with higher rates of 30-day mortality, prolonged LOS ≥5 days, wound complications, sepsis, pulmonary complications, cardiac complications, VTE, UTI, HAC, intra- or postoperative blood transfusion, and unplanned reoperation. Significant predictors of non-home discharge were ASA

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    Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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