Predictors of Non-home Discharge in Elderly Patients Undergoing Multilevel Anterior Cervical Discectomy and Fusion Procedures

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The study aimed to identify perioperative variables associated with non-home discharge in elderly patients undergoing anterior cervical discectomy and fusion. SUMMARY OF BACKGROUND DATA: Anterior cervical discectomy and fusion (ACDF) is the most common cervical spine surgery in the United States, with procedures projected to increase, particularly among elderly patients. Discharge disposition after surgery impacts outcomes and cost, but predictors of non-home discharge in elderly patients undergoing multilevel ACDF remain underexplored. METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was retrospectively queried to identify elderly patients undergoing multilevel ACDF procedures between 2011 and 2023. Multivariable logistic regression was used to identify independent predictors of non-home discharge. Restricted cubic spline models assessed nonlinear associations for continuous variables. RESULTS: Among 10,565 elderly patients undergoing multilevel ACDF procedures, 800 patients (7.6%) were discharged to non-home facilities. Older age (OR=1.103 per year, 95% CI: 1.087-1.119, P <0.001), female sex (OR=1.310, 95% CI: 1.119-1.534, P <0.001), Black race (OR=2.186, 95% CI: 1.743-2.727, P <0.001), operative time (OR=1.045 per 10 min, 95% CI: 1.034-1.056, P <0.001), inpatient admission (OR=5.189, 95% CI: 4.016-6.816, P <0.001), diabetes (non-insulin-dependent OR=1.291, 95% CI: 1.057-1.572, P =0.012; insulin-dependent OR=1.682, 95% CI: 1.313-2.141, P <0.001), and functional dependence (partially dependent OR=6.232, 95% CI: 4.629-8.368; totally dependent OR=7.147, 95% CI: 2.642-19.85; P <0.001) were independent predictors of non-home discharge. Spline models revealed nonlinear associations for age ( P =0.034) and BMI ( P <0.001), with elevated risk at both BMI extremes, but no nonlinearity for operative time ( P =0.835). CONCLUSION: Older age, female sex, Black race, longer operative time, inpatient admission, diabetes, and functional dependence were identified as independent predictors of non-home discharge in elderly patients undergoing multilevel ACDF. These findings can be used to improve risk stratification and informed consent for elderly patients undergoing multilevel ACDF procedures.