{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T06:58:33Z","timestamp":1785308313850,"version":"3.55.0"},"reference-count":90,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,7]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Surgery for cervical spondylotic myelopathy (CSM) is becoming increasingly common and costly. Using propensity score matching to rigorously control for demographic, clinical, and surgical confounders, the authors provide the most refined assessment yet of the impact of discharge to subacute rehabilitation (SAR) or home with health services on excess length of stay (LOS) and inpatient expense following surgery for CSM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The prospective Quality Outcomes Database was used to assess patients undergoing surgery for CSM. Propensity score matching was used to balance 12 covariates between patients discharged home and those discharged to SAR, as well as between patients discharged home and those discharged home with health services. The mean LOS, complications, and patient-reported outcomes (at baseline and 3, 12, and 24 months postoperatively) were compared between discharge destinations. Excess LOS was multiplied by the adjusted expense per inpatient day to calculate excess expense.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>After matching, there were no significant baseline differences between discharge cohorts. Discharge to SAR was associated with a mean excess LOS of 2.7 days and an additional inpatient expense of $8168, while discharge home with health services resulted in a mean excess LOS of 0.9 days and an additional inpatient expense of $2723. Patients discharged to SAR had lower patient satisfaction at 3 months, worse EQ-5D scores at 12 and 24 months, and worse modified Japanese Orthopaedic Association scores at 3 months. Those discharged home with health services had lower patient satisfaction and EQ-5D scores at 12 months postoperatively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>These findings underscore the need for proactive, targeted discharge planning to minimize prolonged LOS and reduce healthcare costs, particularly in the context of increasingly common elective CSM surgery and the emergence of alternative payment models. By optimizing discharge processes, payors and hospital administrators can improve resource utilization, enhance patient satisfaction, and reduce financial burdens on healthcare systems.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.7.spine25398","type":"journal-article","created":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T20:53:17Z","timestamp":1763412797000},"page":"216-225","source":"Crossref","is-referenced-by-count":1,"title":["Impact of discharge to subacute rehabilitation or home with health services on prolonged length of stay and increased inpatient expense following elective surgery for cervical spondylotic myelopathy: a propensity score\u2013matched Quality Outcomes Database study"],"prefix":"10.3171","volume":"44","author":[{"given":"Harrison J.","family":"Howell","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farhan A.","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Praveen V.","family":"Mummaneni","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of California, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan A.","family":"Shlobin","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dean","family":"Chou","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony M.","family":"DiGiorgio","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of California, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamad","family":"Bydon","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Chicago, Illinois;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erica F.","family":"Bisson","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Utah, Salt Lake City, Utah;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher I.","family":"Shaffrey","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Duke University, Durham, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oren N.","family":"Gottfried","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Duke University, Durham, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony L.","family":"Asher","sequence":"additional","affiliation":[{"name":"Neuroscience Institute and Spine Center of Excellence, Wake Forest University School of Medicine and Advocate Health, Charlotte, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domagoj","family":"Coric","sequence":"additional","affiliation":[{"name":"Neuroscience Institute and Spine Center of Excellence, Wake Forest University School of Medicine and Advocate Health, Charlotte, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric A.","family":"Potts","sequence":"additional","affiliation":[{"name":"Goodman Campbell Brain and Spine, Indianapolis, Indiana;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin T.","family":"Foley","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Tennessee, Semmes Murphey Neurologic and Spine Institute, Memphis, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael Y.","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Miami, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai-Ming","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Weill Cornell Medical Center, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael S.","family":"Virk","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Weill Cornell Medical Center, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John J.","family":"Knightly","sequence":"additional","affiliation":[{"name":"Atlantic Neurosurgical Specialists, Morristown, New Jersey;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott A.","family":"Meyer","sequence":"additional","affiliation":[{"name":"Atlantic Neurosurgical Specialists, Morristown, New Jersey;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Tennessee, Semmes Murphey Neurologic and Spine Institute, Memphis, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheerag D.","family":"Upadhyaya","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun-Po","family":"Yen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan S.","family":"Uribe","sequence":"additional","affiliation":[{"name":"Barrow Neurological Institute, Phoenix, Arizona; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis M.","family":"Tumial\u00e1n","sequence":"additional","affiliation":[{"name":"Barrow Neurological Institute, Phoenix, Arizona; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay D.","family":"Turner","sequence":"additional","affiliation":[{"name":"Barrow Neurological Institute, Phoenix, Arizona; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Regis W.","family":"Haid","sequence":"additional","affiliation":[{"name":"Atlanta Brain and Spine Care, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew K.","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"12","key":"b1","series-title":"Spine (Phila Pa 1976).","first-page":"E675","article-title":"Degenerative cervical myelopathy: epidemiology, genetics, and pathogenesis","volume":"40","author":"Nouri A","year":"2015","unstructured":"Nouri A, Tetreault L, Singh A, Karadimas SK, Fehlings MG. 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Global Spine J. 2022;12(8):1792\u20131803."},{"issue":"2","key":"b9","series-title":"Spine (Phila Pa 1976).","first-page":"E22","article-title":"Socioeconomic status impacts length of stay and nonhome discharge disposition after posterior cervical decompression and fusion","volume":"50","author":"Opara OA","year":"2025","unstructured":"Opara OA, Narayanan R, Issa T,  Socioeconomic status impacts length of stay and nonhome discharge disposition after posterior cervical decompression and fusion. Spine (Phila Pa 1976).2025;50(2):E22\u2013E28."},{"issue":"2","key":"b10","series-title":"J Spine Surg Hong Kong","first-page":"264","article-title":"Discharge to skilled-care or rehabilitation following elective anterior cervical discectomy and fusion increases the risk of 30-day re-admissions and post-discharge complications","volume":"4","author":"Malik AT","year":"2018","unstructured":"Malik AT, Jain N, Yu E, Kim J, Khan SN. 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A QOD prospective registry study. J Neurosurg Spine. 2024;40(4):453\u2013464."},{"issue":"1","key":"b16","series-title":"J Neurosurg Spine","first-page":"25","article-title":"Identifying patients at risk for nonroutine discharge after surgery for cervical myelopathy: an analysis from the Quality Outcomes Database","volume":"35","author":"Mummaneni PV","year":"2021","unstructured":"Mummaneni PV, Bydon M, Knightly JJ,  Identifying patients at risk for nonroutine discharge after surgery for cervical myelopathy: an analysis from the Quality Outcomes Database. J Neurosurg Spine. 2021;35(1):25\u201333."},{"issue":"3","key":"b17","series-title":"Neurosurg Focus","first-page":"E2","article-title":"Three-level ACDF versus 3-level laminectomy and fusion: are there differences in outcomes? 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J Neurosurg Spine. 2023;38(1):42\u201355."},{"issue":"1","key":"b19","series-title":"J Neurosurg Spine","first-page":"11","article-title":"Do comorbid self-reported depression and anxiety influence outcomes following surgery for cervical spondylotic myelopathy?","volume":"39","author":"Chan AK","year":"2023","unstructured":"Chan AK, Shaffrey CI, Park C,  Do comorbid self-reported depression and anxiety influence outcomes following surgery for cervical spondylotic myelopathy?. J Neurosurg Spine. 2023;39(1):11\u201327."},{"issue":"6","key":"b20","series-title":"Neurosurg Focus","first-page":"E5","article-title":"Which supervised machine learning algorithm can best predict achievement of minimum clinically important difference in neck pain after surgery in patients with cervical myelopathy? 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