Home Versus Rehabilitation: Factors that Influence Disposition After Minimally Invasive Surgery in Adult Spinal Deformity Surgery Robert K. Eastlack 1,2 , Justin B. Ledesma 2 , Stacie Tran 2 , Amrit Khalsa 2 , Paul Park 3 , Praveen V. Mummaneni 4 , Dean Chou 4 , Adam S. Kanter 5 , Neel Anand 6 , Pierce Nunley 7 , Frank La Marca 8 , Richard G. Fessler 9 , Juan S. Uribe 10 , Gregory M. Mundis Jr 1,2 , International Spine Study Group - BACKGROUND: Minimally invasive surgery (MIS) correc- tion for adult spinal deformity (ASD) may reduce the need the need for postoperative skilled nursing facility (SNF) or inpa- tient rehabilitation (IR) placement following surgery. The likelihood of requiring placement in a facility rather than home disposition may be influenced by various factors. In addition, the associations between discharge location and outcomes and complication rates have not been elucidated in these patients. In this study, we aimed to define factors predicting disposition to an SNF/IR and to elucidate the rates of compli- cations occurring in patients sent to home versus to a facility. - METHODS: A retrospective review of a multicenter ASD database, which included patients who underwent surgery between 2009 and 2014. Inclusion criteria were age >18 years, MIS as part of index surgery, location of discharge, and at least 1 of the following: pelvic tilt >20  , sagittal vertical axis >5 cm, pelvic incidenceelumbar lordosis mismatch >10, or lumbar scoliosis >20  . Patients with a 2- year follow-up were included. Preoperative demographic and radiographic data, postoperative (<30 day) complica- tions, and health-related quality of life were analyzed. - RESULTS: A total of 182 patients met our inclusion criteria, including 113 who were discharged to home and 69 who were discharged to an SNF/IR. Older patients (>50 years) were more likely to be discharged to an SNF/IR (P [ 0.043). Those aged >70 years were 6-fold more likely to go to an SNF/IR. No as- sociation was identified between discharge to an SNF/IR and any radiographic parameters except preoperative pelvic tilt (odds ratio [OR], 1.11; P [ 0.009). Staged cases were more likely to be discharged to an SNF/IR (OR, 3.24; 95% confidence interval, 1.11e9.46; P [ 0.032); otherwise, there was no dif- ference in levels treated, operating time, estimated blood loss, osteotomy, or length of hospital stay. Patients requiring discharge to an SNF/IR had a higher rate of complications (58% vs. 39.8%; P [ 0.017), including major complications (19.5% vs. 42%; P [ 0.001), perioperative complications (14.2% vs. 31.9%; P [ 0.004) and infections (3.5% vs. 13%; P [ 0.016). Patients discharged to an SNF/IR had a higher rate of revision (19.5% vs. 33%; P [ 0.035). Health-related quality of life measures were similar regardless of disposition. - CONCLUSIONS: Older patients and those undergoing staged MIS deformity correction have a higher likelihood of postoperative disposition to an SNF/IR. Complications occurred more commonly in those patients requiring transfer to an SNF/IR after hospitalization. Key words - Adult spinal deformity - Discharge disposition - Minimally invasive surgery Abbreviations and Acronyms ASD: Adult spinal deformity EBL: Estimated blood loss HRQOL: Health-related quality of life IR: Inpatient rehabilitation LL: Lumbar lordosis MIS: Minimally invasive surgery ODI: Oswestry Disability Index OR: Odds ratio PI: Pelvic incidence PT : Pelvic tilt SNF: Skilled nursing facility SVA: Sagittal vertical axis VAS: Visual analog score From the 1 Department of Orthopedic Surgery, Scripps Clinic, La Jolla, California; 2 Department of Orthopedic Surgery, San Diego Spine Foundation, San Diego, California; 3 Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan; 4 Department of Neurosurgery, University of California, San Francisco, San Francisco, California; 5 Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania; 6 Department of Neurosurgery, Cedars-Sinai, Los Angeles, California; 7 Department of Neurosurgery, Louisiana Spine Institute, Shreveport, Louisiana; 8 Department of Neurosurgery, Henry Ford Allegiance Health, Jackson, Michigan; 9 Department of Neurosurgery, Rush University, Chicago, Illinois; and 10 Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA To whom correspondence should be addressed: Robert K. Eastlack, M.D. [E-mail: reastlack@gmail.com] Citation: World Neurosurg. (2018). https://doi.org/10.1016/j.wneu.2018.06.249 Journal homepage: www.WORLDNEUROSURGERY.org Available online: www.sciencedirect.com 1878-8750/$ - see front matter ª 2018 Elsevier Inc. All rights reserved. WORLD NEUROSURGERY -: e1-e6, - 2018 www.WORLDNEUROSURGERY.org e1 Original Article