Rehabilitation Characteristics Predicting Post-Operative Discharge Location after Surgery for Cauda Equina Syndrome: A Retrospective Analysis

Research Objectives: To investigate the factors associated with acute care discharge location to a skilled nursing facility (SNF) after surgery for Cauda Equina Syndrome (CES) to decrease costs, assist with appropriate discharge recommendations, and improve patient outcomes.

Design: Retrospective cohort study

Setting: Single hospital system

Participants: Patients (n=114) who received surgery for CES with subsequent discharge from the hospital

Interventions: All patients had surgery for CES performed by either an orthopedic surgeon or neurosurgeon. Most of the patients (n=91) received rehabilitation in the hospital prior to discharge.

Main Outcome Measures: Primary outcome measure was discharge location to SNF or home. Data collected included patient demographics, type of surgery performed, pre-operative symptoms, intra-operative characteristics, post-operative symptoms, and levels of performance and assistance in post-operative physical therapy in the hospital.

Results: Total patients (n=114) had an average age (standard deviation) of 55.4 (18.1) years. Average duration of CES symptoms prior to surgery was 43.7 (99.4) days. Factors associated with discharge to SNF after surgery for CES include non-married status (p=0.03), increased estimated blood loss (EBL) during surgery (p=0.02), increased length of stay (p < 0.01), the presence of pre-operative bowel and bladder symptoms (p=0.02), lower pre-operative motor scores and post-operative motor scores (p < 0.01), greater post-operative bed mobility assistance (p < 0.01), decreased first distance walked at first physical therapy evaluation in the hospital (p < 0.01), and decreased total distance walked during length of stay (LOS) at the hospital (p < 0.01). Multivariate analysis revealed decreased total distance walked during LOS is associated with discharge to SNF (p < 0.02).

Conclusions: Post-operative discharge to SNF following surgery for CES is associated with level of assistance during physical therapy sessions, decreased ambulation in the hospital after surgery, non-married status, LOS, pre-operative bowel/bladder symptoms, increased EBL, and lower pre-operative and post-operative motor scores. Further research may assist with appropriate discharge determination to improve patient outcomes after surgery for CES.

Author(s) Disclosures: None of the authors have any conflicts to disclose.