{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T06:58:41Z","timestamp":1785308321319,"version":"3.55.0"},"reference-count":28,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>More than 8000 patients are treated annually for vertebral column tumors, of whom roughly two-thirds will be discharged to an inpatient facility (nonroutine discharge). Nonroutine discharge is associated with increased care costs as well as delays in discharge and poorer patient outcomes. In this study, the authors sought to develop a prediction model of nonroutine discharge in the population of vertebral column tumor patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Patients treated for primary or metastatic vertebral column tumors at a single comprehensive cancer center were identified for inclusion. Data were gathered regarding surgical procedure, patient demographics, insurance status, and medical comorbidities. Frailty was assessed using the modified 5-item Frailty Index (mFI-5) and medical complexity was assessed using the modified Charlson Comorbidity Index (mCCI). Multivariable logistic regression was used to identify independent predictors of nonroutine discharge, and multivariable linear regression was used to identify predictors of prolonged length of stay (LOS). The discharge model was internally validated using 1000 bootstrapped samples.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>The authors identified 350 patients (mean age 57.0 \u00b1 13.6 years, 53.1% male, and 67.1% treated for metastatic vs primary disease). Significant predictors of prolonged LOS included higher mCCI score (\u03b2 = 0.74; p = 0.026), higher serum absolute neutrophil count (\u03b2 = 0.35; p = 0.001), lower hematocrit (\u03b2 = \u22120.34; p = 0.001), use of a staged operation (\u03b2 = 4.99; p &lt; 0.001), occurrence of postoperative pulmonary embolism (\u03b2 = 3.93; p = 0.004), and surgical site infection (\u03b2 = 9.93; p &lt; 0.001). Significant predictors of nonroutine discharge included emergency admission (OR 3.09; p = 0.001), higher mFI-5 score (OR 1.90; p = 0.001), lower serum albumin level (OR 0.43 per g\/dL; p &lt; 0.001), and operations with multiple stages (OR 4.10; p &lt; 0.001). The resulting statistical model was deployed as a web-based calculator (<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/jhuspine4.shinyapps.io\/Nonroutine_Discharge_Tumor\/\">https:\/\/jhuspine4.shinyapps.io\/Nonroutine_Discharge_Tumor\/<\/jats:ext-link>).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>The authors found that nonroutine discharge of patients with surgically treated vertebral column tumors was predicted by emergency admission, increased frailty, lower serum albumin level, and staged surgical procedures. The resulting web-based calculator tool may be useful clinically to aid in discharge planning for spinal oncology patients by preoperatively identifying patients likely to require placement in an inpatient facility postoperatively.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2020.6.spine201024","type":"journal-article","created":{"date-parts":[[2020,11,20]],"date-time":"2020-11-20T07:18:31Z","timestamp":1605856711000},"page":"364-373","source":"Crossref","is-referenced-by-count":19,"title":["Predicting nonroutine discharge in patients undergoing surgery for vertebral column tumors"],"prefix":"10.3171","volume":"34","author":[{"given":"Jeff","family":"Ehresman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zach","family":"Pennington","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Feghali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Schilling","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Hersh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bethany","family":"Hung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Lubelski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel M.","family":"Sciubba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"9","key":"b1","series-title":"Spine J","doi-asserted-by":"publisher","first-page":"1844","DOI":"10.1016\/j.spinee.2013.11.029","article-title":"Trends in the surgical treatment for spinal metastasis and the in-hospital patient outcomes in the United States from 2000 to 2009","volume":"14","author":"Yoshihara H","year":"2014","unstructured":"Yoshihara H, Yoneoka D. Trends in the surgical treatment for spinal metastasis and the in-hospital patient outcomes in the United States from 2000 to 2009. Spine J. 2014;14(9):1844\u20131849.10.1016\/j.spinee.2013.11.02924291034"},{"issue":"1 Suppl","key":"b2","series-title":"Global Spine J","doi-asserted-by":"publisher","first-page":"98S","DOI":"10.1177\/2192568219830323","article-title":"Essential concepts for the management of metastatic spine disease: what the surgeon should know and practice","volume":"9","author":"Barzilai O","year":"2019","unstructured":"Barzilai O, Boriani S, Fisher CG,  Essential concepts for the management of metastatic spine disease: what the surgeon should know and practice. Global Spine J. 2019;9(1 Suppl):98S\u2013107S.10.1177\/219256821983032331157152"},{"issue":"10","key":"b3","series-title":"JAMA Surg","doi-asserted-by":"publisher","first-page":"956","DOI":"10.1001\/jamasurg.2013.2148","article-title":"Excessively long hospital stays after trauma are not related to the severity of illness: let\u2019s aim to the right target!","volume":"148","author":"Hwabejire JO","year":"2013","unstructured":"Hwabejire JO, Kaafarani HMA, Imam AM,  Excessively long hospital stays after trauma are not related to the severity of illness: let\u2019s aim to the right target! JAMA Surg. 2013;148(10):956\u2013961.2396560210.1001\/jamasurg.2013.2148"},{"issue":"suppl 1","key":"b4","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"S74","DOI":"10.1007\/s00586-009-1115-5","article-title":"Outcome and cost of spinal fractures and spinal tumors","volume":"19","author":"Du Bois M","year":"2010","unstructured":"Du Bois M, Donceel P. Outcome and cost of spinal fractures and spinal tumors. Eur Spine J. 2010;19(suppl 1):S74\u2013S78.10.1007\/s00586-009-1115-519669805"},{"issue":"2","key":"b5","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"177","DOI":"10.3171\/2020.1.SPINE191464","article-title":"Cost-benefit analysis of tranexamic acid and blood transfusion in elective lumbar spine surgery for degenerative pathologies","volume":"33","author":"Ehresman J","year":"2020","unstructured":"Ehresman J, Pennington Z, Schilling A,  Cost-benefit analysis of tranexamic acid and blood transfusion in elective lumbar spine surgery for degenerative pathologies. J Neurosurg Spine. 2020;33(2):177\u2013185.10.3171\/2020.1.SPINE191464"},{"issue":"9761","key":"b6","series-title":"Lancet","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1016\/S0140-6736(10)61351-7","article-title":"Prediction of adverse maternal outcomes in pre-eclampsia: development and validation of the fullPIERS model","volume":"377","author":"von Dadelszen P","year":"2011","unstructured":"von Dadelszen P, Payne B, Li J,  Prediction of adverse maternal outcomes in pre-eclampsia: development and validation of the fullPIERS model. Lancet. 2011;377(9761):219\u2013227.10.1016\/S0140-6736(10)61351-721185591"},{"issue":"1","key":"b7","series-title":"Ann Intern Med","doi-asserted-by":"publisher","first-page":"W1","DOI":"10.7326\/M14-0698","article-title":"Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD): explanation and elaboration","volume":"162","author":"Moons KGM","year":"2015","unstructured":"Moons KGM, Altman DG, Reitsma JB,  Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD): explanation and elaboration. Ann Intern Med. 2015;162(1):W1\u2013W73.10.7326\/M14-069825560730"},{"issue":"2","key":"b8","series-title":"J Pediatr Psychol","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1093\/jpepsy\/jst062","article-title":"A primer on receiver operating characteristic analysis and diagnostic efficiency statistics for pediatric psychology: we are ready to ROC","volume":"39","author":"Youngstrom EA","year":"2014","unstructured":"Youngstrom EA. A primer on receiver operating characteristic analysis and diagnostic efficiency statistics for pediatric psychology: we are ready to ROC. J Pediatr Psychol. 2014;39(2):204\u2013221.2396529810.1093\/jpepsy\/jst062"},{"key":"b9","series-title":"BMJ","doi-asserted-by":"publisher","first-page":"b2393","DOI":"10.1136\/bmj.b2393","article-title":"Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls","volume":"338","author":"Sterne JAC","year":"2009","unstructured":"Sterne JAC, White IR, Carlin JB,  Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls. BMJ. 2009;338:b2393.1956417910.1136\/bmj.b2393"},{"issue":"6","key":"b10","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"1433","DOI":"10.1007\/s00586-019-05928-z","article-title":"Predicting discharge placement after elective surgery for lumbar spinal stenosis using machine learning methods","volume":"28","author":"Ogink PT","year":"2019","unstructured":"Ogink PT, Karhade AV, Thio QCBS,  Predicting discharge placement after elective surgery for lumbar spinal stenosis using machine learning methods. Eur Spine J. 2019;28(6):1433\u20131440.3094152110.1007\/s00586-019-05928-z"},{"issue":"5","key":"b11","series-title":"Neurosurg Focus","doi-asserted-by":"publisher","first-page":"E6","DOI":"10.3171\/2018.8.FOCUS18340","article-title":"Development of machine learning algorithms for prediction of discharge disposition after elective inpatient surgery for lumbar degenerative disc disorders","volume":"45","author":"Karhade AV","year":"2018","unstructured":"Karhade AV, Ogink P, Thio Q,  Development of machine learning algorithms for prediction of discharge disposition after elective inpatient surgery for lumbar degenerative disc disorders. Neurosurg Focus. 2018;45(5):E6.10.3171\/2018.8.FOCUS1834030453463"},{"key":"b12","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"e427","DOI":"10.1016\/j.wneu.2018.11.183","article-title":"Predictors of discharge disposition following laminectomy for intradural extramedullary spinal tumors","volume":"123","author":"Ahn A","year":"2019","unstructured":"Ahn A, Phan K, Cheung ZB,  Predictors of discharge disposition following laminectomy for intradural extramedullary spinal tumors. World Neurosurg. 2019;123:e427\u2013e432.3050057910.1016\/j.wneu.2018.11.183"},{"issue":"2","key":"b13","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"125","DOI":"10.3171\/2013.9.SPINE13274","article-title":"Discharge dispositions, complications, and costs of hospitalization in spinal cord tumor surgery: analysis of data from the United States Nationwide Inpatient Sample, 2003\u20132010","volume":"20","author":"Sharma M","year":"2014","unstructured":"Sharma M, Sonig A, Ambekar S, Nanda A. Discharge dispositions, complications, and costs of hospitalization in spinal cord tumor surgery: analysis of data from the United States Nationwide Inpatient Sample, 2003\u20132010. J Neurosurg Spine. 2014;20(2):125\u2013141.2428653010.3171\/2013.9.SPINE13274"},{"issue":"19","key":"b14","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1535","DOI":"10.1097\/BRS.0000000000001575","article-title":"Predictors of discharge destination after lumbar spine fusion surgery","volume":"41","author":"Aldebeyan S","year":"2016","unstructured":"Aldebeyan S, Aoude A, Fortin M,  Predictors of discharge destination after lumbar spine fusion surgery. Spine (Phila Pa 1976). 2016;41(19):1535\u20131541.10.1097\/BRS.000000000000157527010996"},{"issue":"10","key":"b15","series-title":"Spine J","doi-asserted-by":"publisher","first-page":"1845","DOI":"10.1016\/j.spinee.2018.03.022","article-title":"Predictors of adverse discharge disposition in adult spinal deformity and associated costs","volume":"18","author":"Passias PG","year":"2018","unstructured":"Passias PG, Poorman GW, Bortz CA,  Predictors of adverse discharge disposition in adult spinal deformity and associated costs. Spine J. 2018;18(10):1845\u20131852.10.1016\/j.spinee.2018.03.02229649611"},{"issue":"3","key":"b16","series-title":"Global Spine J","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1177\/2192568217717971","article-title":"Predictors for non-home patient discharge following elective adult spinal deformity surgery","volume":"8","author":"Di Capua J","year":"2018","unstructured":"Di Capua J, Somani S, Lugo-Fagundo N,  Predictors for non-home patient discharge following elective adult spinal deformity surgery. Global Spine J. 2018;8(3):266\u2013272.10.1177\/219256821771797129796375"},{"key":"b17","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"e584","DOI":"10.1016\/j.wneu.2018.10.108","article-title":"Discharge to inpatient care facility after anterior lumbar interbody fusion: incidence, predictors, and postdischarge outcomes","volume":"122","author":"Malik AT","year":"2019","unstructured":"Malik AT, Kim J, Yu E, Khan SN. Discharge to inpatient care facility after anterior lumbar interbody fusion: incidence, predictors, and postdischarge outcomes. World Neurosurg. 2019;122:e584\u2013e590.10.1016\/j.wneu.2018.10.10831108074"},{"issue":"4","key":"b18","series-title":"Global Spine J","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1177\/2192568218797090","article-title":"Predictive factors for discharge destination following posterior lumbar spinal fusion: a Canadian Spine Outcome and Research Network (CSORN) study","volume":"9","author":"Morcos MW","year":"2019","unstructured":"Morcos MW, Jiang F, McIntosh G,  Predictive factors for discharge destination following posterior lumbar spinal fusion: a Canadian Spine Outcome and Research Network (CSORN) study. Global Spine J. 2019;9(4):403\u2013408.10.1177\/2192568218797090"},{"issue":"4","key":"b19","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"523","DOI":"10.3171\/2019.9.SPINE19644","article-title":"Predictors of nonroutine discharge among patients undergoing surgery for grade I spondylolisthesis: insights from the Quality Outcomes Database","volume":"32","author":"Mummaneni PV","year":"2020","unstructured":"Mummaneni PV, Bydon M, Knightly J,  Predictors of nonroutine discharge among patients undergoing surgery for grade I spondylolisthesis: insights from the Quality Outcomes Database. J Neurosurg Spine. 2020;32(4):523\u2013532.10.3171\/2019.9.SPINE19644"},{"issue":"3","key":"b20","series-title":"J Rehabil Med","doi-asserted-by":"publisher","first-page":"246","DOI":"10.2340\/16501977-0506","article-title":"Evaluating inpatient public rehabilitation in Australia using a utilization review tool developed in North America","volume":"42","author":"Poulos CJ","year":"2010","unstructured":"Poulos CJ. Evaluating inpatient public rehabilitation in Australia using a utilization review tool developed in North America. J Rehabil Med. 2010;42(3):246\u2013253.2041122010.2340\/16501977-0506"},{"issue":"6","key":"b21","series-title":"J Arthroplasty","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1016\/j.arth.2006.05.003","article-title":"Postdischarge costs in arthroplasty surgery","volume":"21","author":"Lavernia CJ","year":"2006","unstructured":"Lavernia CJ, D\u2019Apuzzo MR, Hernandez VH,  Postdischarge costs in arthroplasty surgery. J Arthroplasty. 2006;21(6)(suppl 2):144\u2013150.1695007710.1016\/j.arth.2006.05.003"},{"issue":"11","key":"b22","series-title":"J Bone Joint Surg Am","doi-asserted-by":"publisher","first-page":"e55","DOI":"10.2106\/JBJS.16.00166","article-title":"Post-discharge care duration, charges, and outcomes among Medicare patients after primary total hip and knee arthroplasty","volume":"99","author":"Ponnusamy KE","year":"2017","unstructured":"Ponnusamy KE, Naseer Z, El Dafrawy MH,  Post-discharge care duration, charges, and outcomes among Medicare patients after primary total hip and knee arthroplasty. J Bone Joint Surg Am. 2017;99(11):e55.10.2106\/JBJS.16.0016628590385"},{"key":"b23","series-title":"Iowa Orthop J","first-page":"147","article-title":"Risk factors for nonroutine discharge in patients undergoing spinal fusion for intervertebral disc disorders","volume":"35","author":"Best MJ","year":"2015","unstructured":"Best MJ, Buller LT, Falakassa J, Vecchione D. Risk factors for nonroutine discharge in patients undergoing spinal fusion for intervertebral disc disorders. Iowa Orthop J. 2015;35:147\u2013155.26361458"},{"issue":"3","key":"b24","series-title":"Int J Epidemiol","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1093\/ije\/27.3.513","article-title":"Predictors of inappropriate hospital days in a department of internal medicine","volume":"27","author":"Chopard P","year":"1998","unstructured":"Chopard P, Perneger TV, Gaspoz J-M,  Predictors of inappropriate hospital days in a department of internal medicine. Int J Epidemiol. 1998;27(3):513\u2013519.10.1093\/ije\/27.3.513"},{"issue":"1","key":"b25","series-title":"BMC Health Serv Res","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1186\/1472-6963-11-291","article-title":"Determining level of care appropriateness in the patient journey from acute care to rehabilitation","volume":"11","author":"Poulos CJ","year":"2011","unstructured":"Poulos CJ, Magee C, Bashford G, Eagar K. Determining level of care appropriateness in the patient journey from acute care to rehabilitation. BMC Health Serv Res. 2011;11(1):291.2204028110.1186\/1472-6963-11-291"},{"issue":"4","key":"b26","series-title":"Prof Case Manag","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1097\/01.PCAMA.0000327413.01849.04","article-title":"The birth of InterQual: evidence-based decision support criteria that helped change healthcare","volume":"13","author":"Mitus AJ","year":"2008","unstructured":"Mitus AJ. The birth of InterQual: evidence-based decision support criteria that helped change healthcare. Prof Case Manag. 2008;13(4):228\u2013233.1863600810.1097\/01.PCAMA.0000327413.01849.04"},{"issue":"3","key":"b27","series-title":"Eur J Phys Rehabil Med","first-page":"355","article-title":"Stroke rehabilitation: availability of a family member as caregiver and discharge destination","volume":"50","author":"Tanwir S","year":"2014","unstructured":"Tanwir S, Montgomery K, Chari V, Nesathurai S. Stroke rehabilitation: availability of a family member as caregiver and discharge destination. Eur J Phys Rehabil Med. 2014;50(3):355\u2013362.24518145"},{"issue":"1","key":"b28","series-title":"BMC Geriatr","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1186\/s12877-016-0187-4","article-title":"Factors influencing home discharge after inpatient rehabilitation of older patients: a systematic review","volume":"16","author":"Everink IHJ","year":"2016","unstructured":"Everink IHJ, van Haastregt JCM, van Hoof SJM,  Factors influencing home discharge after inpatient rehabilitation of older patients: a systematic review. BMC Geriatr. 2016;16(1):5.2675520610.1186\/s12877-016-0187-4"}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/34\/3\/article-p364.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/34\/3\/article-p364.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/34\/3\/article-p364.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,28]],"date-time":"2025-06-28T01:08:24Z","timestamp":1751072904000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/34\/3\/article-p364.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3]]},"references-count":28,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.3171\/2020.6.spine201024","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2021,3]]}}}