The association of discharge destination with 30-day rehospitalization rates among older adults receiving lumbar spinal fusion surgery.
Chad Cook, Rogelio A Coronado, Janet Prvu Bettger and 1 others
PMID 29358104WHAT IT FOUND
Older adults discharged to rehabilitation services after spinal fusion had higher 30-day readmission rates than those discharged home.
This likely reflects sicker, more complex patients needing skilled care, not harm from the therapy itself. Clinicians should expect higher medical instability in this group.
Key findings
01Patients discharged to rehabilitation-based services had significantly higher odds of 30-day rehospitalization compared to non-rehabilitation destinations, even after adjusting for demographics and comorbidities.
02Rehabilitation-discharged patients were clinically distinct: older, with longer hospital stays, and with more comorbidities than those discharged home.
03The study could not account for functional status, which is the primary determinant of need for post-acute rehabilitation and is strongly associated with readmission risk.
STILL TO COME
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What it does not show
The study did not measure functional status, which is a key reason patients are referred to rehabilitation and a strong predictor of readmission. Administrative data lacked details on surgical severity (simple vs. complex fusion) and the actual intensity or quality of rehabilitation received. The findings may reflect a 'monitoring effect' where patients in skilled settings are watched more closely, leading to higher detection and readmission for issues that might go unnoticed at home. Results are specific to Medicare fee-for-service beneficiaries and may not generalize to other insurance populations.
Declared interests
One author receives royalties from Pearson Education, consulting fees from the Hawkins Foundation, speaking fees, and a Department of Defense grant. Another author has grants from NIDILRR and AHRQ. Other authors declared no competing interests.
The easy way to misread this
Do not interpret the higher readmission rate as evidence that rehabilitation services cause harm. The data shows these patients are older, sicker, and have longer hospital stays, suggesting they are referred to rehab because they are at higher risk for complications, not that the rehab itself increases that risk.