A new study published in the Journal of Neurosurgery: Spine examines factors that predict length of stay, discharge to inpatient rehabilitation and hospital readmission after lumbar spine surgery using a new grading scale: Carolina-Semmes.
Study authors examined data from patients prospectively enrolled in the Quality and Outcomes Database registry who underwent lumbar spine surgery at one to three levels. They then applied the Carolina-Semmes grading scale — constructed using LOS, discharge to inpatient facility and 90-day readmission independent predictors — as a measure of overall performance.
Findings were confirmed later after using the new scale at Charlotte, N.C.-based Carolina Neurosurgery & Spine Associates and Memphis, Tenn.-based Semmes Murphey Clinic. There were 6,921 patients analyzed in the study.
Here are five notes on key findings:
1. Around 4.2 percent of the patients required extended length of stay; 9.4 percent of patients required inpatient facility care or rehabilitation after hospital discharge; and 6.8 percent of patients were readmitted within 90 days of discharge.
2. Independent predictors of the unplanned extended LOS, inpatient facility discharge and 90-day hospital readmission include:
• 70 years or more in age
• American Society of Anesthesiologists class III
• Oswestry Disability Index score of 70 or above
• Medicare or Medicaid insurance
• Nonindependent ambulation
• Fusion
3. The Carolina-Semmes scale stratified the incidence of extended LOS, discharge to a facility and readmissions "in a stepwise fashion in both the aggregate QOD data set and when subsequently applied to the CNSA/Semmes Murphey practice groups."
4. The study authors concluded the Carolina-Semmes grading scale is effective in gauging overall performance for lumbar spine surgery patients. "The grading scale may be helpful in identifying patients who may require additional resource utilization within the global period after surgery," concluded the study authors.
5. As healthcare, specifically orthopedic and spine surgeries, moves toward episode-of-care payments and bundled payments, healthcare providers taking on risk for outcomes and readmissions will find this data helpful in deciding which patients will be candidates for risk-based payment programs.