Introduction: Almost one-quarter of cervical spine surgery in the United States is performed to treat degenerative cervical myelopathy (DCM). These surgeries are offered to increasingly elderly patients with poor baseline functional status, who may require in-patient disposition postoperatively for rehabilitation or nursing care. We sought to identify factors associated with in-patient disposition after elective surgery for DCM, using granular hospital-level data.
Methods: We reviewed all elective surgeries for DCM at a single center in a recent one-year period. We identified patients who were discharged to an in-patient facility and constructed a propensity-matched cohort of patients who were discharged home. We compared preoperative and in-hospital factors between groups.
Results: We identified 28 DCM patients who met inclusion criteria and were discharged to an in-patient facility. We next identified 49 matched cases who were discharged home. There were no significant differences in age/demographics, smoking status, or prior surgeries between groups. Patients with private insurance were more likely to be discharged home (p=0.033).
Myelopathy severity was associated with in-patient disposition, reflected by higher Nurick grade (p < 0.001), motor weakness (p < 0.001), and bowel/bladder symptoms (p=0.024). Neck pain was more prevalent in the home-discharge group (p=0.010).
There were no significant differences in anterior/posterior approach (p=0.060), number of levels decompressed/fixated via either approach, blood loss, operative time, or operative/perioperative complications. Postoperative hospitalization was greater in the in-patient disposition cohort (p < 0.001).
Conclusion : Expectedly, patients with more severe myelopathy had a higher rate of in-patient disposition after surgery. Interestingly, those with private insurance were more likely to go home; this may reflect higher socioeconomic status with more options for home safety equipment and outpatient therapies. Postoperative length of stay was greater in the in-patient disposition group, which likely reflects delays in selecting and financing a facility.
How to Improve Patient Care: By anticipating which patients may require in-patient disposition, some of this planning could be performed preoperatively and thereby shorten hospital admissions after elective surgery for DCM.
