Taryn E LeRoy¹, Andrew Mason², David Tybor³, Jonna Capecci⁴, Louis Jenis⁴ and Ashley Rogerson¹*

¹Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA, USA
²University of Minnesota Medical Center, Minneapolis, MN, USA
³Tufts University School of Medicine, Boston, MA, USA
⁴Department of Orthopaedic Surgery, Mass General Brigham - Newton Wellesley Hospital, Newton, MA, USA

*Corresponding Author: Ashley Rogerson, Department of Orthopaedic Surgery, Mass General Brigham - Newton Wellesley Hospital, Newton, MA, USA.

Received: July 06, 2021; Published:

Abstract

Background: Various forms of scoring tools have been utilized to predict discharge disposition after joint arthroplasty surgery but there is limited data following spine surgery. The aim of this study was to develop a Risk Assessment and Predictor Tool (RAPT) for patients undergoing lumbar fusion surgery to preoperatively assess patient disposition and coordinate discharge after lumbar spine fusion surgery.

Methods: Retrospective review of 300 patients undergoing lumbar spine fusion surgery at a single center from January 1, 2014 - December 31, 2014. Patient demographics, intraoperative, and postoperative data were collected. Patients discharged to an inpatient rehabilitation facility or skilled nursing facility were compared to those discharged home to determine which variables were significantly different between the groups. Variables with the highest predictive accuracy were used to develop the Preoperative Discharge Assessment Tool (PDAT).

Results: A total of 300 patients were analyzed of which 227 (76%) were discharged directly home and 73 (24%) were discharged to a rehab facility. The mean and standard deviation (SD) length of stay (LOS) was 3 ± 1 days for all patients. Variables included in the final scoring tool were American Society of Anesthesiologists physical status classification (ASA) classification, number of levels fused, home living situation, and preoperative assistive device (AD) use. Overall predictive accuracy of the PDAT was 85.5%. Fifteen patients preferred to be discharged to rehab and 14 (93.3%) of those patients were ultimately discharged to rehab. These patients were older (67.9 vs 58.5 years) and more often lived alone (46.2% vs 7.0%).

Conclusion: Patients that were discharged to rehab shared similar characteristics to those in previously published reports in arthroplasty and spine literature. Patients discharged to inpatient rehab were more likely to be older, have higher a higher body mass index (BMI), live alone, and undergo larger operations. Higher estimated blood loss (EBL), longer surgical time, and more levels fused, were all associated with discharge to rehab. Our scoring tool (PDAT) uses preoperative living situation, assistive device (AD) use, number of levels fused, and ASA classification to preoperatively predict discharge destination. It has similar predictive properties to the RAPT, which is currently used in patients undergoing hip or knee arthroplasty. Patient preference for a discharge to rehab should be taken into consideration as well. 

Keywords: Discharge Disposition; RAPT; Discharge Tool; Scoring Tool; Predicting Discharge; Preoperative Assessment

References

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Citation

Citation: Ashley Rogerson., et al. “Preoperative Discharge Assessment Tool (PDAT): Predicting Disposition After Lumbar Spine Fusion".Acta Scientific Orthopaedics 4.8 (2021): 39-44.

Copyright

Copyright: © 2021 Ashley Rogerson., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.