• Azeem Tariq Malik, Jeffery Kim, Elizabeth Yu, and Safdar N Khan.
• The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
• World Neurosurg. 2019 Feb 1; 122: e584-e590.

BackgroundDespite a significant number of patients being discharged to inpatient care facilities after anterior lumbar interbody fusion (ALIF), the current literature remains limited regarding the predictors associated with a nonhome discharge and the impact of continued inpatient care in a facility on postdischarge outcomes.MethodsThe 2013-2016 American College of Surgeons National Surgical Quality Improvement Program was queried using Current Procedural Terminology (CPT) codes for ALIF (CPT-22558) and additional level fusions (CPT-22585). Discharge to inpatient care facilities included discharge to skilled care facilities and/or inpatient rehabilitation units.ResultsIndependent predictors of an inpatient care facility discharge were age older than 45 years (P < 0.001), female sex (P < 0.001), more than 10% body weight loss in the last 6 months prior to surgery (P=0.012), American Society of Anesthesiologists grade greater than II (P=0.005), undergoing a 2-level (P < 0.001) or more than 2-level fusion (P=0.017), a length of stay greater than 3 days (P < 0.001), and the occurrence of any predischarge complication (P < 0.001). After adjustment for differences in clinical and baseline characteristics between the 2 groups, discharge to an inpatient care facility after ALIF was independently associated with higher odds of any postdischarge complication (P=0.010), postdischarge wound complication (P=0.005), and postdischarge septic complications (P=0.011). No significant impact was seen on 30-day readmissions (P=0.943), 30-day reoperations (P=0.228), and 30-day mortality (P=0.913).ConclusionsWith an increasing focus toward minimizing costs associated with postacute care, providers should understand the need of appropriate preoperative risk stratification and construction of care pathways aimed at a home discharge to reduce the occurrence and/or risk of experiencing postdischarge complications.Copyright © 2018 Elsevier Inc. All rights reserved.

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