The association of discharge destination with 30-day rehospitalization rates among older adults receiving lumbar spinal fusion surgery.

Journal Article (Journal Article)

BACKGROUND: As defined by Medicare (United States), post-acute rehabilitation services include care provided in inpatient rehabilitation units and facilities, skilled nursing facilities, long-term acute hospitals, and by home health services. METHODS: We retrospectively evaluated the use of rehabilitation-based post-acute services among Medicare beneficiaries who were hospitalized for lumbar spinal fusion (ICD-9-CM procedure codes 81.04-81.08) in 2012-2014, examined the case-mix for those discharged to rehabilitation- and non-rehabilitation based services, and determined the association between these categories of discharge disposition and 30-day rehospitalization. The independent effect of rehabilitation-based discharge destination on 30-day readmissions was examined with a generalized linear mixed model, first adjusting for patient characteristics and then stratified by clusters that delineated more homogenous clinical profiles. RESULTS: Among 261,558 Medicare beneficiaries with lumbar spinal fusion surgery, 50.8% were discharged to a rehabilitation-based post-acute services. Patients discharged to rehabilitation-based services were older and had more comorbidities, and had longer hospital lengths of stays. After adjusting for patient and hospital characteristics, patients discharged to rehabilitation-based post-acute care had increased odds of 30-day rehospitalization than those without discharge to other destinations (OR 1.36; 95%CI = 1.31, 1.40). Analysis of patients by clinical profile clusters found similar results. CONCLUSIONS: Clinical profiles of Medicare beneficiaries who had lumbar spinal fusion surgery and were discharged to rehabilitation-based post-acute services included more comorbidities than those discharged to non-rehabilitation based settings. Controlling for these differences did not mediate the negative association between use of rehabilitation-based post-acute services and 30-day readmission.

Full Text

Duke Authors

Cited Authors

  • Cook, C; Coronado, RA; Bettger, JP; Graham, JE

Published Date

  • April 2018

Published In

Volume / Issue

  • 34 /

Start / End Page

  • 77 - 82

PubMed ID

  • 29358104

Pubmed Central ID

  • PMC6047066

Electronic International Standard Serial Number (EISSN)

  • 2468-7812

Digital Object Identifier (DOI)

  • 10.1016/j.msksp.2018.01.003


  • eng

Conference Location

  • Netherlands