{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:56:05Z","timestamp":1785372965350,"version":"3.55.0"},"reference-count":17,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2024,2,27]],"date-time":"2024-02-27T00:00:00Z","timestamp":1708992000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Introduction: After adult spinal deformity (ASD) surgery, patients often require postoperative rehabilitation at an inpatient rehabilitation (IPR) center or a skilled nursing facility (SNF). However, home discharge is often preferred by patients and hsas been shown to decrease costs. In a cohort of patients undergoing ASD surgery, we sought to (1) report the incidence of discharge to home, (2) determine the factors significantly associated with discharge to home in the form of a simple scoring system, and (3) evaluate the impact of discharge disposition on patient-reported outcome measures (PROMs). Methods: A single-institution, retrospective cohort study was undertaken for patients undergoing ASD surgery from 2009 to 2021. Inclusion criteria were \u2265 5-level fusion, sagittal\/coronal deformity, and at least 2-year follow-up. Exposure variables included preoperative, perioperative, and radiographic data. The primary outcome was discharge status (dichotomized as home vs. IPR\/SNF). Secondary outcomes included PROMs, such as the numeric rating scales (NRSs) for back and leg pain, the Oswestry Disability Index (ODI), and EQ-5D. A subanalysis comparing IPR to SNF discharge was conducted. Univariate analysis was performed. Results: Of 221 patients undergoing ASD surgery with a mean age of 63.6 \u00b1 17.6, 112 (50.6%) were discharged home, 71 (32.2%) were discharged to an IPR center, and 38 (17.2%) were discharged to an SNF. Patients discharged home were significantly younger (55.7 \u00b1 20.1 vs. 71.8 \u00b1 9.1, p &lt; 0.001), had lower rate of 2+ comorbidities (38.4% vs. 45.0%, p = 0.001), and had less hypertension (57.1% vs. 75.2%, p = 0.005). Perioperatively, patients who were discharged home had significantly fewer levels instrumented (10.0 \u00b1 3.0 vs. 11.0 \u00b1 3.4 levels, p = 0.030), shorter operative times (381.4 \u00b1 139.9 vs. 461.6 \u00b1 149.8 mins, p &lt; 0.001), less blood loss (1101.0 \u00b1 977.8 vs. 1739.7 \u00b1 1332.9 mL, p &lt; 0.001), and shorter length of stay (5.4 \u00b1 2.8 vs. 9.3 \u00b1 13.9 days, p &lt; 0.001). Radiographically, preoperative SVA (9.1 \u00b1 6.5 vs. 5.2 \u00b1 6.8 cm, p &lt; 0.001), PT (27.5 \u00b1 11.1\u00b0 vs. 23.4 \u00b1 10.8\u00b0, p = 0.031), and T1PA (28.9 \u00b1 12.7\u00b0 vs. 21.6 \u00b1 13.6\u00b0, p &lt; 0.001) were significantly higher in patients who were discharged to an IPR center\/SNF. Additionally, the operating surgeon also significantly influenced the disposition status (p &lt; 0.001). A scoring system of the listed factors was proposed and was validated using univariate logistic regression (OR = 1.55, 95%CI = 1.34\u20131.78, p &lt; 0.001) and ROC analysis, which revealed a cutoff value of &gt; 6 points as a predictor of non-home discharge (AUC = 0.75, 95%CI = 0.68\u20130.80, p &lt; 0.001, sensitivity = 63.3%, specificity = 74.1%). The factors in the scoring system were age &gt; 56, comorbidities \u2265 2, hypertension, TIL \u2265 10, operative time &gt; 357 mins, EBL &gt; 1200 mL, preop SVA &gt; 6.6 cm, preop PT &gt; 33.6\u00b0, and preop T1PA &gt; 15\u00b0. When comparing IPR (n = 71) vs. SNF (n = 38), patients discharged to an SNF were significantly older (74.4 \u00b1 8.6 vs. 70.4 \u00b1 9.1, p = 0.029) and were more likely to be female (89.5% vs. 70.4%, p = 0.024). Conclusions: Approximately 50% of patients were discharged home after ASD surgery. A simple scoring system based on age &gt; 56, comorbidities \u2265 2, hypertension, total instrumented levels \u2265 10, operative time &gt; 357 mins, EBL &gt; 1200 mL, preop SVA &gt; 6.6 cm, preop PT &gt; 33.6\u00b0, and preop T1PA &gt; 15\u00b0 was proposed to predict non-home discharge. These findings may help guide postoperative expectations and resource allocation after ASD surgery.<\/jats:p>","DOI":"10.3390\/jcm13051340","type":"journal-article","created":{"date-parts":[[2024,2,27]],"date-time":"2024-02-27T03:35:48Z","timestamp":1709004948000},"page":"1340","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Who Can Be Discharged Home after Adult Spinal Deformity Surgery?"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6857-1569","authenticated-orcid":false,"given":"Soren","family":"Jonzzon","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hani","family":"Chanbour","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graham W.","family":"Johnson","sequence":"additional","affiliation":[{"name":"School of Medicine, Vanderbilt University, Nashville, TN 37235, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey W.","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Baylor College of Medicine, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tyler","family":"Metcalf","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5128-5757","authenticated-orcid":false,"given":"Alexander T.","family":"Lyons","sequence":"additional","affiliation":[{"name":"School of Medicine, Vanderbilt University, Nashville, TN 37235, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iyan","family":"Younus","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Campbell","family":"Liles","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amir M.","family":"Abtahi","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA"},{"name":"Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Byron F.","family":"Stephens","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA"},{"name":"Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott L.","family":"Zuckerman","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA"},{"name":"Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,2,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"8S","DOI":"10.1177\/2192568219828729","article-title":"Evolution and Advancement of Adult Spinal Deformity Research and Clinical Care: An Overview of the Scoli-RISK-1 Study","volume":"9","author":"Cerpa","year":"2019","journal-title":"Glob. 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