Tag: Discharge destination

Posted on

Predictors for Patient Discharge Destination After Elective Anterior Cervical Discectomy and Fusion

Spine 2017;42:1538–1544

Study Design. Retrospective study of prospectively collected data.

Objective. To identify risk factors for nonhome patient discharge after elective anterior cervical discectomy and fusion (ACDF).

Summary of Background Data. ACDF is one of the most performed spinal procedures and this is expected to increase in the coming years. To effectively deal with an increasing patient volume, identifying variables associated with patient discharge destination can expedite placement applications and subsequently reduce hospital length of stay.

Methods. The 2011 to 2014 ACS-NSQIP database was queried using Current Procedural Terminology (CPT) codes 22551 or 22554. Patients were divided into two cohorts based on discharge destination. Bivariate and multivariate logistic regression analyses were employed to identify predictors for patient discharge destination and extended hospital length of stay.

Results. A total of 14,602 patients met the inclusion criteria for the study of which 498 (3.4%) had nonhome discharge. Multivariate logistic regression found that Hispanic versus Black race/ ethnicity (odds ratio, OR¼0.21, 0.05–0.91, P¼0.037), American Indian or Alaska Native, Asian, Native Hawaiian or Pacific Islander versus Black race/ethnicity (OR¼0.52, 0.34–0.80, p-value¼0.003), White versus Black race/ethnicity (OR¼0.55, 0.42–0.71), elderly age 65 years (OR¼3.32, 2.72–4.06), obesity (OR¼0.77, 0.63–0.93, P¼0.008), diabetes (OR¼1.32, 1.06–1.65, P¼0.013), independent versus partially/totally dependent functional status (OR¼0.11, 0.08–0.15), operation time 4hours (OR¼2.46, 1.87–3.25), cardiac comorbidity (OR ¼1.38, 1.10– 1.72, P ¼0.005), and ASA Class 3 (OR¼2.57, 2.05–3.20) were predictive factors in patient discharge to a facility other than home. In addition, multivariate logistic regression analysis also found nonhome discharge to be the most predictive variable in prolonged hospital length of stay.

Conclusion. Several predictive factors were identified in patient discharge to a facility other than home, many being preoperative variables. Identification of these factors can expedite patient discharge applications and potentially can reduce hospital stay, thereby reducing the risk of hospital acquired conditions and minimizing health care costs.

Level of Evidence: 3

Posted on

Impact of Weekend Presentation on Short-Term Outcomes and Choice of Clipping vs Coiling in Subarachnoid Hemorrhage

Neurosurgery 81:87–91, 2017

Presentation on a weekend is commonly associated with higher mortality and a decreased likelihood of receiving invasive procedures.

OBJECTIVE: To determine whether weekend presentation influences mortality, discharge destination, or type of treatment received (clip vs coil) in subarachnoid hemorrhage (SAH).

METHODS: We performed a serial cross-sectional retrospective study using the Nationwide Inpatient Sample. All adult discharges with a primary diagnosis of SAH (ICD-9-CM 435) from 2005 to 2010 were included, and records with trauma or arteriovenous malformation were excluded. Unadjusted and adjusted associations between weekend presentation and 3 outcomes (in-hospital mortality, discharge destination, and treatment with clip vs coil) were estimated using chi-square tests and multilevel logistic regression.

RESULTS: A total of 46 093 admissions for nontraumatic SAH were included in the sample; 24.6% presented on a weekend, 68.9% on a weekday, and 6.5% had unknown day of presentation. Weekend admission was not a significant predictor of inpatient mortality (25.4% weekend vs 24.9% weekday; P = .44), or a combined poor outcome measure of mortality or discharge to long-term acute care or hospice (30.3% weekend vs 29.4% weekday; P = .23). Among those treated for aneurysm obliteration, the proportion of clipped vs coiled did not change with weekend vs weekday presentation (21.5% clipped with weekend presentation vs 21.6% weekday, P = .95; 21.5% coiled with weekend presentation vs 22.4% weekday, P = .19).

CONCLUSION: Presentation with nontraumatic SAH on a weekend did not influence mortality, discharge destination, or type of treatment received (clip vs coil) compared with weekday presentation.

 

Proudly powered by WordPress