Patients undergoing spinal surgery for metastatic disease face a heightened risk of nonroutine discharge, often leading to increased healthcare costs and higher readmission rates. A new scoping review sheds light on the multifaceted factors that contribute to these nonstandard discharge outcomes, offering critical insights for US healthcare professionals managing spinal metastases.
The study systematically analyzed nine studies to pinpoint the risk factors associated with nonroutine discharge among surgical patients with spinal metastases. Using a rigorous methodology aligned with the Arksey and O’Malley framework, the research team conducted searches across PubMed, Web of Science, and CINAHL databases, extracting and synthesizing data to categorize the key risk domains.
The findings identified three overarching domains influencing discharge outcomes: sociodemographic factors, disease-related factors, and broader health and process-related issues. Notably, age, race, insurance status, marital status, and family involvement emerged as significant sociodemographic variables. Disease-specific contributors included spinal cord injury grade, serum albumin level, BMI, the segment of spinal surgery performed, and whether the procedure was elective or emergent. Additionally, functional dependency before surgery, ASA grade, and activities of daily living at discharge were linked to higher odds of nonroutine discharge.
Beyond these, other influential elements such as the frailty index, comorbidity index, and efficiency of the referral or discharge process also played critical roles in determining discharge outcomes. Together, these factors underscore the complexity of post-surgical care planning for patients with spinal metastases.
The authors emphasize the importance of early identification of at-risk patients and advocate for comprehensive, nurse-led discharge strategies. Such proactive planning could reduce hospital stays and prevent complications, ultimately improving patient outcomes and alleviating healthcare system burdens.
As the population of patients with spinal metastases grows, these insights serve as a valuable guide for healthcare providers in enhancing discharge processes and optimizing patient care.
Reference:
Liu S et al. The risk factors influencing nonroutine discharge in surgical patients with spinal metastases: a scoping review. J Orthop Surg Res. 2024;19:86.
