Predicting discharge placement and health care needs after lumbar spine laminectomy.

OBJECTIVE: To explore factors associated with discharge placement (DP) and need for skilled assistance after patients are discharged from hospital following lumbar laminectomy. METHODS: A retrospective analysis of 339 patients who underwent lumbar laminectomy was conducted. We used multivariable logistic regression analysis to identify significant covariates and to construct two regression models: a primary model to predict DP, home vs inpatient rehabilitation/skilled nursing facility (IR/SNF), and a secondary model to predict the need for skilled assistance once patients are discharged to home. RESULTS: The sample included 48.7% females, 68.2% married, 56.3% independent in daily activities, and 85.2% discharged to home. Subjects were a mean 56.06±12.75 years old and had a BMI of 31.35±6.2. Of those discharged to home, 17.7% needed skilled assistance. Patients stayed 4.41±3.55 days in the hospital and walked 203.38±144.87 ft during hospital stay. Age, distance walked during hospital stay, and length of hospital stay (LOS) were significant positive predictors for discharge to home vs IR/SNF, whereas single living status, diminished prior level of function, and longer LOS were predictors of need for skilled assistance after discharge to home. CONCLUSION: Age, mobility, marital status, prior level of function, and LOS are key variables in determining healthcare needs following lumbar laminectomy. J Allied Health 2014; 43(2):88-97.IN THE UNITED STATES, there has been an increase in the prevalence of lumbar spine surgeries (LSS), with a similar increase in surgery costs and related post-surgical care.1-3 The prevalence of these surgeries in the U.S. is approximately 0.2% of the population, which is at least 40% higher than in other countries and five times higher than in England and Scotland.4-6 This rise in LSS in the last decade has increased the demands for optimizing surgical outcomes and the need to establish evidencebased guidelines for patient's health care needs during their hospital stay and after hospital discharge.7-10Lumbar laminectomy is a common surgical procedure, primarily for the treatment of lumbar stenosis in elderly patients.11 Current randomized controlled trials support lumbar laminectomy over conservative management.12 Patients who received spine surgery reported significant improvement in pain, function, and quality of life which was maintained for 4 years.13 However, the results of spinal surgeries are not always consistent and present significant variation in short- and long-term outcomes.14 Implementation of post-surgical interventions such as rehabilitation and post-surgical care may optimize surgical outcomes.14Studies have investigated possible pre- and post-surgical factors to predict short- and long-term outcomes.10,15-21 Patient-related factors such as age, gender, work status, comorbidities, preoperative pain intensity and duration, work status, and emotional and psychological factors (e.g., fear of movement, anxiety, and depression), were found to be associated with post-surgical outcomes.15,17-19,21-23Intraoperative factors have also been shown to influence postsurgical outcomes. Intraoperative fluid infusion, American Society of Anesthesia (ASA) score, physical status, type of surgical procedure, and total intraoperative platelet administration were significant predictors of length of stay (LOS) in an intensive care unit.24 In another study, the number of levels fused, postoperative hemoglobin and hematocrit values, total volume of blood resuscitation, and duration of operation were also significantly correlated with LOS.25 However, these variables have not been investigated for hospital discharge planning and health care needs following hospital discharge.Inpatient physical therapy (PT) assessment plays an important role in discharge planning. However, PT assessment and functional status are rarely studied as possible predictors of short- or long-term outcomes after LSS. …