56. The development of a predictive scoring system for discharge to a facility following posterior spinal fusion for adult spinal deformity

BACKGROUND CONTEXT Discharge to a rehabilitation or skilled nursing facility following elective surgical treatment of adult spinal deformity is common. However, this practice carries a number of disadvantages, including an increased cost of care to the patient and the health care system, and the potential for increased risk of postoperative complications. Uncertainty regarding a patient's discharge plan may also prolong the initial hospitalization, further contributing to the cost of care. As bundled-care payment systems become increasingly common, the cost associated with discharge to a facility may adversely affect the reimbursement of inpatient surgical fees. Given the many variables involved in the care of patients with adult spinal deformity, determining which patients will require discharge to a facility vs home has remained a challenge for interdisciplinary care teams. PURPOSE The aim of this study was to develop a risk stratification system by identifying risk factors for discharge to a facility following surgery for patients with adult spinal deformity. STUDY DESIGN/SETTING Retrospective prognostic study. PATIENT SAMPLE Consecutive patients who underwent elective posterior spinal fusion for adult deformity at a single academic institution from 2008 to 2014 were identified. Patients were excluded from analysis if they were under 18 years old, had a prior thoracolumbar surgery, or deceased during the hospitalization. OUTCOME MEASURES The primary outcome measure analyzed was discharge to a facility. Patient factors analyzed included age, sex, Charlson Comorbidity Index (CCI), American Society of Anesthesiologists (ASA) score, BMI, smoking status, and history of prior spine surgery. Surgical/hospitalization factors analyzed included number of fusion levels, number of single column osteotomies, presence of a three column osteotomy, operative duration, and length of hospital stay. METHODS To determine risk factors for discharge to a facility, a stepwise multivariate logistic regression was used, which initially included all preoperative variables and sequentially excluded nonsignificant variables until only those with p RESULTS A total of 208 patients were included, and 98 (47.12%) were discharged to a facility. Backwards stepwise multivariate logistic regression found the following risk factors for discharge to a facility: age (p=0.032), ASA score of three or more (p=0.032), and presence of a three column osteotomy (p 85% with 12 or more total points. CONCLUSIONS A point-scoring system for predicting discharge to facility after posterior spinal fusion for adult spinal deformity was developed. Age, ASA score of three or more, and three-column osteotomy were the primary factors that influenced this outcome. These findings may help interdisciplinary care teams to streamline discharge planning, reduce overall costs, and improve the quality of care. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.