Predictors of Admission to Post-Acute Rehabilitation Following Multi-Level Spinal Decompression and Fusion Surgery and Its Associated Outcomes

OBJECTIVE

To investigate predictive factors and outcomes in those admitted to post-acute rehabilitation (PAR) versus those that discharged home following multi-level spinal decompression and fusion surgery.

METHODS

Retrospective case review study of adults that underwent multi-level spinal decompression and fusion surgery between 2016 and 2022 at an academic institution. Preoperative, perioperative, postoperative, and outcomes variables were compared between those discharged home versus PAR. Finally, multiple logistic regression was used to determine factors contributing to PAR admission.

RESULTS

Of 241 total patients, 89 (37%) discharged home and 152 (63%) discharged to PAR. Among home discharge patients, 45.9% used an assistive device, while among PAR patients, 61.5% used 1 (P = 0.041). Mean pre-operative Oswestry Disability Index score was significantly lower in the home discharge group compared to the PAR discharge group (40.3 vs. 45.3 respectively, P = 0.044). Females were 2.43 times more likely to be discharged to PAR compared to males (95% CI: 1.06, 5.54, P = 0.04). Patients with a mood disorder had 2.81 times higher odds of being discharged to PAR compared to those without (95% CI: 1.20, 6.60, P = 0.02). Other variables evaluated were not statistically significant.

CONCLUSIONS

Female sex and presence of a mood disorder increase the likelihood to PAR discharge following multi-level spinal decompression surgery.

Robotics in the hematology laboratory. An evaluation of the productivity of the Sysmex HS-330

The productivity of a robotic hematology system (Sysmex HS-330) was compared with that of existing automated, semi-automated, and manual systems (Coulter Counter-Model STKS; Sysmex R-1000 reticulocyte counter. Geometric Data Miniprep slide maker, respectively) in the clinical hematology laboratory of a large hospital. On average, for a batch of 50 samples, the HS-330 performed a blood count with a 5-part differential, a reticulocyte count, and prepare a blood smear 23 minutes faster than could trained technologists using existing equipment. An estimated 1.8 medical technologists could be assigned to other tasks; however, because of the equipment's high cost, in a laboratory processing 1,000 samples per day, 4.6 years would be needed before any actual cost savings were experienced.

Accuracy and utility of differential white blood cell count in the neonatal intensive care unit

The clinical utility of the complete blood cell count (including the differential white blood cell count) as a means to follow the course of infants in a neonatal intensive care unit was assessed. Utility was judged for three purposes: (1) predicting the onset of clinically unrecognized disease, (2) assessing the severity of current disease, and (3) following a trend during treatment. Neither conventional nor automated differential counts were useful for surveillance (predicting the onset of clinically unrecognized disease). The white blood cell count, the platelet count, and the absolute immature neutrophil count and immature/total neutrophil ratio were useful to assess the severity of current clinical events. The white blood cell count was superior to the differential count for following trends in patients' conditions. Information regarding nuclear immaturity derived from automated counts and the cost and slowness of the manual differential count are good indications for decreased use of conventional counts, increased use of certain features of the automated differential, or both, in neonatal intensive care units.

Laboratory evaluation of differential white blood cell count information from the Coulter S-plus IV and Technicon H-1 in patient populations requiring rapid "turnaround" time

Automated differential counts produced by the Coulter S-Plus IV (S + 4) and the Technicon H-1 (H-1) were compared with routine and reference manual differentials with the use of samples from the adult emergency room (ER) and the neonatal intensive care unit (NICU), populations in which rapid reporting of laboratory results is considered important. Error rates for routine technologists were 9.3% in the ER and 15.3% in the NICU. Error rates for the two instruments were higher than those for technologists with samples from the ER but could be reduced to 4-5% if instrument flags and additional criteria were used to signal the need for a conventional differential. Instrument error rates were higher yet with NICU samples, and specificity was very low (10% for each device). There were small differences between the instruments in detection of immature neutrophils, but flags from the H-1 were more specific (except for detection of nucleated red blood cells in samples from the ER). If either instrument were used in an adult ER and flags and additional criteria were used to signal the need for conventional differentials, 64-75% fewer manual counts would be performed with no decrease in accuracy and a considerable improvement in turnaround time.