Omar H Tarawneh, Rajkishen Narayanan, Jonathan Dalton, Robert J Oris, Mark Miller, Matthew Meade, Jarod Olson, Nicholas B Pohl, Tariq Z Issa, Olivia A Opara, Emily Berthiaume, Gokul Karthikeyan, Logan Witt, Aayush Mehta, Barrett I Woods, Mark F Kurd, I David Kaye, Jose A Canseco, Alan S Hilibrand, Alexander R Vaccaro, Christopher K Kepler, Gregory D Schroeder
{"title":"Predictors of Successful Early Discharge in Revision Lumbar Fusion.","authors":"Omar H Tarawneh, Rajkishen Narayanan, Jonathan Dalton, Robert J Oris, Mark Miller, Matthew Meade, Jarod Olson, Nicholas B Pohl, Tariq Z Issa, Olivia A Opara, Emily Berthiaume, Gokul Karthikeyan, Logan Witt, Aayush Mehta, Barrett I Woods, Mark F Kurd, I David Kaye, Jose A Canseco, Alan S Hilibrand, Alexander R Vaccaro, Christopher K Kepler, Gregory D Schroeder","doi":"10.1016/j.spinee.2025.07.024","DOIUrl":null,"url":null,"abstract":"<p><strong>Background context: </strong>Reducing length of hospital stay (LOS) and establishing earlier discharge goals are critically important in terms of improving patient satisfaction and maximizing value in spine surgery. Revision lumbar fusion is associated with higher costs and longer inpatient stays compared to primary surgery. Identifying factors that correlate with safe early discharge in this population can inform efforts to improve the value of care.</p><p><strong>Purpose: </strong>This study aims to evaluate predictors of successful early discharge following revision lumbar fusion.</p><p><strong>Study design/setting: </strong>Retrospective Cohort PATIENT SAMPLE: Patients who underwent 1-2 level revision lumbar fusion from 2011 to 2022 were included.</p><p><strong>Outcome measures: </strong>Emergency department (ED) visits within 30 days postoperatively and readmissions within 30- and 90-days were recorded. Sub-analyses of patient-reported outcome measures (PROMs) and postoperative opioid use were performed.</p><p><strong>Methods: </strong>Patients were stratified as early and late discharge, with those in the lowest 25% of LOS classified as achieving early discharge. Early and late discharge groups were compared for outcome measures on bivariate and multivariate analyses.</p><p><strong>Results: </strong>Of the 479 patients included, 150 were in the early discharge group (LOS 1.85 vs 4.37 days, p<0.001). Male sex was an independent predictor of early discharge (OR: 1.82, P=0.010), while higher BMI (OR=0.95, P=0.010), index procedure being a fusion (OR: 0.57, P=0.022), nonunion (OR=0.27, P=0.014) as the revision indication, and increased surgical duration (OR: 0.995, P=0.019) demonstrated decreased odds of early discharge. Early discharge patients experienced greater VAS-back (-4.04 vs -2.58, p= 0.031), and VAS-leg (-4.32 vs -2.14, p=0.008) improvement at 90 days. ED visits (7.33% vs 3.34%, p=0.080) and 90-day readmissions (4.00% vs. 5.17%, p=0.746) were similar between groups.</p><p><strong>Conclusions: </strong>Elevated BMI, fusion as the index procedure, revisions due to non-union, and longer operative time independently reduced the likelihood of early discharge. VAS scores for back and leg pain, were significantly better in the early DC group. No differences existed in postoperative ED visits or readmissions, highlighting the potential for safe, early discharges in the appropriately selected patient.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.7000,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Spine Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.spinee.2025.07.024","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background context: Reducing length of hospital stay (LOS) and establishing earlier discharge goals are critically important in terms of improving patient satisfaction and maximizing value in spine surgery. Revision lumbar fusion is associated with higher costs and longer inpatient stays compared to primary surgery. Identifying factors that correlate with safe early discharge in this population can inform efforts to improve the value of care.
Purpose: This study aims to evaluate predictors of successful early discharge following revision lumbar fusion.
Study design/setting: Retrospective Cohort PATIENT SAMPLE: Patients who underwent 1-2 level revision lumbar fusion from 2011 to 2022 were included.
Outcome measures: Emergency department (ED) visits within 30 days postoperatively and readmissions within 30- and 90-days were recorded. Sub-analyses of patient-reported outcome measures (PROMs) and postoperative opioid use were performed.
Methods: Patients were stratified as early and late discharge, with those in the lowest 25% of LOS classified as achieving early discharge. Early and late discharge groups were compared for outcome measures on bivariate and multivariate analyses.
Results: Of the 479 patients included, 150 were in the early discharge group (LOS 1.85 vs 4.37 days, p<0.001). Male sex was an independent predictor of early discharge (OR: 1.82, P=0.010), while higher BMI (OR=0.95, P=0.010), index procedure being a fusion (OR: 0.57, P=0.022), nonunion (OR=0.27, P=0.014) as the revision indication, and increased surgical duration (OR: 0.995, P=0.019) demonstrated decreased odds of early discharge. Early discharge patients experienced greater VAS-back (-4.04 vs -2.58, p= 0.031), and VAS-leg (-4.32 vs -2.14, p=0.008) improvement at 90 days. ED visits (7.33% vs 3.34%, p=0.080) and 90-day readmissions (4.00% vs. 5.17%, p=0.746) were similar between groups.
Conclusions: Elevated BMI, fusion as the index procedure, revisions due to non-union, and longer operative time independently reduced the likelihood of early discharge. VAS scores for back and leg pain, were significantly better in the early DC group. No differences existed in postoperative ED visits or readmissions, highlighting the potential for safe, early discharges in the appropriately selected patient.
背景背景：缩短住院时间（LOS）和建立早期出院目标在提高患者满意度和最大化脊柱外科价值方面至关重要。与初次手术相比，腰椎融合翻修术的费用更高，住院时间更长。在这一人群中确定与安全早期出院相关的因素可以为提高护理价值的努力提供信息。目的：本研究旨在评估腰椎融合翻修术后早期成功出院的预测因素。研究设计/设置：回顾性队列患者样本：纳入2011年至2022年接受1-2节段腰椎融合翻修术的患者。结果测量：记录术后30天内的急诊就诊情况，以及30天和90天内的再入院情况。对患者报告的结果测量（PROMs）和术后阿片类药物使用进行亚分析。方法：将患者分为早出院和晚出院，将LOS最低的25%患者分为早出院。比较早期和晚期出院组的双变量和多变量分析结果。结果：在纳入的479例患者中，150例患者属于早期出院组（LOS 1.85 vs 4.37天）。结论：BMI升高、融合作为指标手术、因不愈合而进行翻修以及较长的手术时间均降低了早期出院的可能性。早期DC组背部和腿部疼痛的VAS评分明显更好。在术后急诊科就诊和再入院方面没有差异，这突出了在适当选择的患者中安全、早期出院的可能性。
期刊介绍：
The Spine Journal, the official journal of the North American Spine Society, is an international and multidisciplinary journal that publishes original, peer-reviewed articles on research and treatment related to the spine and spine care, including basic science and clinical investigations. It is a condition of publication that manuscripts submitted to The Spine Journal have not been published, and will not be simultaneously submitted or published elsewhere. The Spine Journal also publishes major reviews of specific topics by acknowledged authorities, technical notes, teaching editorials, and other special features, Letters to the Editor-in-Chief are encouraged.
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