Non-home discharge disposition after posterior spinal fusion in neuromuscular scoliosis—an analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Pediatric database

Abstract

Background: Despite an increasing trend of corrective surgery in patients with neuromuscular scoliosis, evidence regarding risk factors associated with non-home discharge destination following surgery remains limited. Methods: The 2012–2016 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Pediatric database was queried using Current Procedural Terminology codes for patients undergoing posterior spinal fusion (22802, 22804 and 22808) for neuromuscular scoliosis. Non-home discharge was defined as discharge to a skilled nursing facility, rehabilitation facility and/or separate acute care unit. Patients who expired during inpatient stay were excluded from the study sample. Only patients aged 2–18 years with a primary diagnosis of neuromuscular scoliosis were included in the final cohort. Results: Out of a total of 1,269 patients, 76 (6.0%) had a non-home discharge disposition. Following adjustment for baseline clinical characteristics, patients lying in the age bracket of 15–17 years {odds ratio (OR) 2.27 [95% confidence interval (CI): 1.01–5.08]; P=0.047} or >17 years [OR 2.29 (95% CI: 1.10–4.79); P=0.027], male gender [OR 1.75 (95% CI: 1.06–2.89); P=0.029], having structural pulmonary abnormality at time of surgery [OR 2.01 (95% CI: 1.17–3.43); P=0.011], a length of stay >4 days [OR 2.29 (95% CI: 1.15– 4.55); P=0.018] and having a past history of childhood cancer [OR 4.50 (95% CI: 1.15–17.61); P=0.031] were significant independent predictors associated with a non-home discharge. Conclusions: Providers can utilize these data to pre-operatively identify patients who might require continued high-level/inpatient care in a facility, and subsequently expedite discharge and reduce costs associated with a prolonged inpatient stay.