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Early Discharge for Anterior Cervical Fusion Surgery: Prediction of Readmission and Special Considerations for Older Adults

1
Department of Family Medicine, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan
2
Department of Family Medicine, Taipei Veterans’ General Hospital, Taipei 11217, Taiwan
3
Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei 11221, Taiwan
4
Department of Biomedical Engineering, School of Biomedical Science and Engineering, National Yang-Ming University, Taipei 11221, Taiwan
5
Department of Neurosurgery, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan
6
Department of Neurosurgery, Neurological Institute, Taipei Veterans’ General Hospital, Taipei 11217, Taiwan
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2019, 16(4), 641; https://doi.org/10.3390/ijerph16040641
Received: 27 December 2018 / Revised: 5 February 2019 / Accepted: 14 February 2019 / Published: 21 February 2019
(This article belongs to the Special Issue Efficient Use of Acute Hospital Services for Older People)
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PDF [1564 KB, uploaded 21 February 2019]
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Abstract

Anterior cervical discectomy and fusion (ACDF) is the standard surgical management for disc herniation and spondylosis worldwide and reportedly performed with short hospitalization and early discharge (ED). However, it is unknown if ED improves the outcomes of ACDF including among older adults. This cohort study included patients who underwent ACDF surgery in Taiwan over two years analyzed in two groups: the ED group (discharged within 48 hours), and the comparison group (hospitalized for more than 48 h). Both groups were followed-up for at least 180 days. Pre- and post-operative comorbidities, re-admissions and re-operations were analyzed using a multivariate cox-regression model, with bootstrapping, and Kaplan–Meier analysis. Among 5565 ACDF patients, the ED group (n = 405) had a higher chance (crude and adjusted hazard ratio = 2.33 and 2.39, both p < 0.001) of re-admission than the comparison group (n = 5160). The ED group had an insignificant trend toward more re-admissions for spinal problems and re-operations within 180 days. In the ED group, older age (≥60) and hypertension were predictive of re-admission. For ACDF surgery, the ED group had higher rates of re-admission within 180 days of post-op, suggesting that the current approach to ED requires modification or more cautious selection criteria be adopted, particularly for older adults. View Full-Text
Keywords: anterior cervical discectomy and fusion (ACDF); early discharge (ED); incidence rates; readmission; reoperation anterior cervical discectomy and fusion (ACDF); early discharge (ED); incidence rates; readmission; reoperation
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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
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Chen, Y.-C.; Wu, J.-C.; Chang, H.-K.; Huang, W.-C. Early Discharge for Anterior Cervical Fusion Surgery: Prediction of Readmission and Special Considerations for Older Adults. Int. J. Environ. Res. Public Health 2019, 16, 641.

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