Discharge destination influences risks of readmission and complications after lumbar spine surgery in severely disabled patients

Objective: For individuals with severe disability requiring spine surgery, appropriate discharge destination is a challenging and complex decision. Past studies have found associations between discharge destination and postoperative outcomes but were limited by biases in sampling characteristics. The purpose of this study was to explore whether there is an association between discharge destination and odds of worse postoperative outcomes in high-risk individuals with severe/crippling/bedbound disability who received lumbar spine surgery. Methods: This was an observational study using the Quality Outcomes Database Spine Registry. Subjects were limited to age 18 years, primary lumbar spine surgery, and severe disability at baseline (Oswestry Disability Index [ODI] >50%). Discharge destination was dichotomized to home or healthcare institution. Results: Of the 13,050 patients, 11,859 patients (90.9%) were discharged home and 1191 (9.1%) patients were discharged to a healthcare institution. Individuals who were discharged to a healthcare institution were older (68.6 vs 56.9 p < 0.001) and had worse baseline characteristics (higher American Society of Anesthesiology [ASA] score, presence of back pain, and prevalence of comorbidities, all p < 0.001) compared to those who were discharged home. In covariate-controlled multivariate analysis, the home discharge cohort had lower rates of hospital readmission (OR = 0.68, 95% CI 0.55, 0.84) and revision surgery (OR = 0.56, 95% CI 0.37, 0.85) within three months and return to operating room (OR = 0.46, 95% CI 0.34-0.63) and complications (all OR < 0.50 except hematoma, p < 0.01) within 30 days than the institution discharge cohort. Conclusion: Severity of disability measured by ODI may influence but does not dictate discharge destination and the associated postoperative outcomes.