103. Discharge to subacute rehabilitation is a predictor of wound complications after spine surgery

BACKGROUND CONTEXT A significant number of patients are discharged to inpatient care facilities after various procedures in spine surgery. However, data are limited regarding the relationship between nonhome disposition and postdischarge surgical outcomes. PURPOSE The aim of this study was to evaluate differences in wound complications and readmission among discharge settings in patients undergoing elective spine surgery for degenerative cervical and lumbar disease (radiculopathy and/or myelopathy). STUDY DESIGN/SETTING This study is a retrospective analysis of prospectively collected data from a single, high-volume academic medical center. PATIENT SAMPLE Patients undergoing one- to three-level lumbar decompression, one- to three-level lumbar decompression and fusion, or posterior cervical decompression and fusion were retrospectively identified. OUTCOME MEASURES The outcomes of interest in this study were wound complications (surgical site infections, wound dehiscence), revision surgery, 30-day readmission, and 90-day readmission. METHODS Patient characteristics, including age, gender, body mass index (BMI), Charlson Comorbidity Index (CCI), and discharge setting (home, acute rehabilitation, subacute rehabilitation) were collected. Patients were stratified into those discharged to home/self-care (home), those discharged to inpatient rehabilitation (acute), and those discharged to skilled nursing or long-term rehabilitation (subacute). A multivariate logistic regression model was developed to identify variables associated with wound complications. RESULTS A total of 623 patients were included in the final analysis, with 480 patients in the Home group, 72 patients in the Acute group, and 80 patients in the Subacute group. Acute and Subacute patients had a higher mean age compared to the Home group (p CONCLUSIONS Our results suggest that discharge to subacute rehabilitation may be associated with an increased risk of wound complications in patients’ status post elective cervical or lumbar surgery. Moreover, our analysis further supports previous reports establishing an association between increased postoperative wound complications and obesity. Patients across all groups utilized a similar amount of resources in terms of readmissions and revision surgery. Surgeons should understand the need for appropriate risk stratification, and when clinically possible and safe, design pathways aimed at home discharge to reduce the occurrence of postoperative wound complications. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.