The Examination of Rehabilitation Factors Associated With Discharge Location After Spine Surgery for Cauda Equina Syndrome

Introduction: Cauda equina syndrome (CES) is a serious medical condition affecting the lumbosacral spine that requires emergent surgical intervention to relieve symptoms and prevent lasting neurological deficits. Previous studies have shown discharge location after CES surgery may have been associated with increased complications and poor outcomes. The purpose of this study is to evaluate factors associated with home or nonhome discharge after surgery for CES to assist with appropriate discharge planning by the medical interdisciplinary team. Review of Literature: Little data exist regarding factors associated with discharge location after surgery for CES. Subjects: One hundred fourteen patients who had surgery for CES in a hospital setting. Methods: This study is a retrospective case control study. Surgery for CES was performed by both orthopedic surgeons and neurosurgeons. Main outcome measure was discharge to home (n = 61) or a nonhome location (n = 53). Data recorded include age, gender, type of surgery performed, preoperative symptoms, postoperative symptoms, and level of participation in physical therapy in the hospital. Statistical analysis included logistic regression with odds ratio (OR) and 95% confidence intervals (CI). Results: Total patients (n = 114) had a mean age of 55.4 ± 18.1 years with 52.6% being male. Some factors associated with home discharge after surgery for CES via univariate analysis included no preoperative bowel/bladder symptoms (OR = 3.12; 95% CI = 1.19-8.19; P = .02), higher preoperative motor score (OR = 2.40; 95% CI = 1.40-4.12; P = .002), increased postoperative motor score (OR = 3.67; 95% CI = 1.62-8.30; P = .002), increased first distance walked (OR = 1.06; 95%CI = 1.02-1.09; P = .002), and increased total distance walked over LOS (OR = 1.01; 95%CI = 1.00-1.01; P = .0001). Multivariate analysis showed that decreased total distance walked during acute care hospital admission was associated with nonhome discharge ( P < .02). Discussion and Conclusion: There are various factors associated with particular discharge locations after CES surgery, such length of hospital stay, preoperative bowel and bladder function, extremity strength scores, and ability to ambulate after surgery with physical therapy. As discharge location may impact patient outcomes, it is important identify which rehabilitation factors may be associated with patient discharge location after surgery for CES.