Postoperative Discharge to Acute Rehabilitation or Skilled Nursing Facility Compared to Home Does Not Reduce Hospital Readmissions, Return to Surgery or Improve Outcomes Following Adult Spine Deformity Surgery

Abstract

Study Design. Retrospective review of a prospective multi-center adult spinal deformity (ASD) study. Objective. Evaluate 30-day readmissions, 90-day return to surgery, postoperative complications, and patient reported outcomes (PROs) for matched ASD patients receiving nonhome discharge (NON), including acute rehabilitation (REHAB) and skilled nursing facility (SNF), or home (HOME) discharge following ASD surgery. Summary of Background Data. Postoperative disposition following ASD surgery frequently involves nonhome discharge. Little data exists for longer term outcomes for ASD patients receiving nonhome discharge versus patients discharged to home. Methods. Surgically treated ASD patients prospectively enrolled into a multicenter study were assessed for NON or HOME disposition following hospital discharge. NON was further divided into REHAB or SNF. Propensity score matching (PSM) was used to match for patient age, frailty, spine deformity, levels fused and osteotomies performed at surgery. Thirty-day hospital readmissions, 90-day return to surgery, postoperative complications, 1-year and minimum 2-year postoperative PROs were evaluated. Results. 241 of 374 patients were eligible for study. NON patients were identified and matched to HOME patients. Following matching, 158 patients remained for evaluation; NON and HOME had similar preoperative age, frailty, spine deformity magnitude, surgery performed, and duration of hospital stay (P>0.05). Thirty-day readmissions, 90-day return to surgery, and postoperative complications were similar for NON versus HOME, and similar for REHAB (N=64) versus SNF (N=42) versus HOME (P>0.05). At 1-year and minimum 2-year follow up, HOME demonstrated similar to better PRO scores including ODI, SF-36 MCS and PCS, and SRS scores versus NON, REHAB and SNF (P<0.05). Conclusion. Acute needs must be considered following ASD surgery, however matched analysis comparing 30-day hospital readmissions, 90-day return to surgery, postoperative complications and PROs demonstrated minimal benefit for NON, REHAB or SNF versus HOME at 1-year and 2-year follow up, questioning the risk and cost/benefits of routine use of nonhome discharge. Level of Evidence. I-IV: Level III; prognostic