Original ArticlePredictors of Discharge Disposition Following Laminectomy for Intradural Extramedullary Spinal Tumors
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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2021, World NeurosurgeryCitation Excerpt :One measure gaining popularity across both medical and surgical specialties is nonroutine discharge to continuing care facilities.2-5 Owing to the need for logistic coordination between care teams and frequent discharge to outside facilities, patients with unanticipated nonroutine discharge have been shown to be at increased risk for prolonged hospital stay and greater resource use following surgery.6-8 Therefore, identifying patient risk factors for nonroutine discharge is necessary to reduce the expensive and potentially avoidable delays in care.
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.