Factors Affecting Discharge Delay in Lumbar Spinal Surgery Patients Who were Treated according to a Critical Pathway

Jeoung Hee Kim; Eun Ha Lee; Su Ran Kim; Sung Reul Kim

doi:10.7469/kjan.2016.28.1.43

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Factors Affecting Discharge Delay in Lumbar Spinal Surgery Patients Who were Treated according to a Critical Pathway

Jeoung Hee Kim¹, Eun Ha Lee¹, Su Ran Kim¹, Sung Reul Kim²

Korean Journal of Adult Nursing 2016;28(1):43-52.
Published online: February 29, 2016

DOI: https://doi.org/10.7469/kjan.2016.28.1.43

¹Department of Nursing, Asan Medical Center, Seoul

²College of Nursing · Research Institute of Nursing Science, Chonbuk National University, Jeonju, Korea

Corresponding author: Kim, Sung Reul College of Nursing, Chonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju 54899, Korea. Tel: +82-63-270-3118, Fax: +82-63-270-3127, E-mail: srkim@jbnu.ac.kr

• Received: October 5, 2015 • Accepted: February 4, 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
REFERENCES

Abstract

Purpose
The aim of this study was to identify demographic, clinical, physical, and psychosocial factors affecting discharge delay in lumbar spinal surgery patients who were treated according to a critical pathway.
Methods
A sample of 170 patients with lumbar spinal surgery agreed to participate in the study, between April 1, 2014 and August 30, 2015. Data were analyzed by mean, standard deviation, t-test, x 2-test, ANCOVA, and logistic regression analysis using SPSS 22.0 program.
Results
Approximately fifty-nine percent of the participants was delayed discharge. On logistic regression analysis, female gender (OR=2.63, 95% CI=1.40~4.94), age (OR=1.03, 95% CI=1.01~1.05), spondylolisthesis (OR=4.49, 95% CI=1.90~10.61), and spinal fusion operation (OR=4.14, 95% CI=1.89~9.05) were significant factors predicting discharge delay of the participants. However, discharge delay was not related with pain, physical function, depression, or family support.
Conclusion
An analysis of discharge delay may assist in evaluating and revising critical pathway for optimal care. In addition, nurses need to understand the factors affecting discharge delay of the given population who were treated according to a critical pathway.
Key Words: Critical pathways; Patient discharge; Lumbar vertebrae

Table 1.

Comparison of Demographic and Clinical Characteristics Between the Planned Discharge Group and the Discharge Delay Group in Lumbar Spinal Surgery Patients Treated According to a Critical Pathway (N=170)

Variables	Categories	Total (n=170)	Planned discharge (n=69)	Discharge delay (n=101)	x2 or t	p
Variables	Categories	n (%) or M±SD	n (%) or M±SD	n (%) or M±SD	x2 or t	p
Gender	Male	82 (48.2)	43 (62.3)	39 (38.6)	9.23	.003
	Female	88 (51.8)	26 (37.7)	62 (61.4)	2.62	.010
		58.9±14.8	55.1±17.1	61.4±12.5
Age (year)	≤40	24 (14.1)
	41~50	21 (12.4)
	51~60	33 (19.4)
	61~70	50 (29.4)
	≥71	42 (24.7)
Marital status	Married	144 (84.7)	58 (84.1)	86 (85.1)	0.04	.832
Marital status	Not-married	26 (15.3)	11 (15.9)	15 (14.9)
Level of education (n=169)	≤Elementary school	39 (22.9)	13 (18.8)	26 (25.7)	3.96	.265
	Middle school	45 (26.5)	15 (21.7)	30 (29.7)
	High school	36 (21.2)	18 (26.2)	18 (17.9)
	≥College	49 (28.8)	23 (33.3)	26 (25.7)
Occupation	Yes	62 (36.5)	30 (43.5)	32 (31.7)	2.46	.117
Occupation	No	108 (63.5)	39 (56.5)	69 (68.3)
Religion	Yes	103 (60.6)	41 (59.4)	62 (61.4)	0.07	.873
Religion	No	67 (39.4)	28 (40.6)	39 (38.6)
Diagnosis	Herniated intervertebral disc	62 (36.5)	34 (49.3)	28 (27.7)	12.49	.002
	Lumbar stenosis	61 (35.9)	25 (36.2)	36 (35.6)
	Spondylolisthesis	47 (27.6)	10 (14.5)	37 (36.6)
Operation	Fusion	60 (35.3)	14 (20.3)	46 (45.5)	13.32	.001
	Laminectomy	49 (28.8)	21 (30.4)	28 (27.7)
	Discectomy	61 (35.9)	34 (49.3)	27 (26.7)
Motor dysfunction at admission	Yes	20 (11.8)	9 (13.0)	11 (10.9)	0.18	.809
Motor dysfunction at admission	No	150 (88.2)	60 (87.0)	90 (89.1)
Sensory dysfunction at admission	Yes	170 (100.0)
Sensory dysfunction at admission
Comorbidity	No	72 (42.4)	33 (47.8)	39 (38.6)	1.43	.233
	Yes	98 (57.6)	36 (52.2)	62 (61.4)
	Cardiovascular disease	75 (44.1)
	Endocrinologic disease	8 (4.7)
	Neurologic disease	4 (2.4)
	Urinary disease	4 (2.4)
	Others	7 (4.1)
Experience of admission	Yes	104 (61.2)	46 (66.7)	58 (57.4)	1.47	.225
Experience of admission	No	66 (38.8)	23 (33.3)	43 (42.6)
Experience of operation	Yes	101 (59.4)	44 (63.8)	57 (56.4)	0.91	.427
Experience of operation	No	69 (40.6)	25 (36.2)	44 (43.6)
Discharge delay				1.1±0.9
	Fusion			1.1±0.8
	Laminectomy			1.3±1.4
		Discectomy			0.8±1.1

Table 2.

Comparison of Physical and Psychosocial Characteristics Between the Planned Discharge Group and the Discharge Delay Group (N=170)

Variables	Categories	Total (n=170)	Planned discharge (n=69)	Discharge delay (n=101)	z or F	p
Variables	Categories	n (%) or M±SD	n (%) or M±SD	n (%) or M±SD	z or F	p
Physical characteristics	Physical function	50.6±16.5	48.5±16.5	52.0±16.3	0.82	.804^†
	Pain
	Pain score at admission	5.8±1.8	5.4±1.6	6.0±1.8	0.87	.594^†
	Mean pain score during	2.9±1.1	2.6±1.1	3.0±1.0	2.00	.051^‡
	hospitalization
	Worst pain score during	5.7±1.8	5.1±1.7	6.1±1.9	1.59	.106^‡
	hospitalization
	Pain score at discharge	1.4±1.0	1.2±0.9	1.5±1.0	1.51	.189^‡
Psychosocial characteristics	Depression	11.2±10.6	9.1±8.5	12.6±11.7	0.74	.878^†
	Type D personality
	Type D	38 (22.4)	14 (20.3)	20 (19.8)	0.29	.708
	Non-type D	132 (77.6)	55 (79.7)	68 (67.3)
	Family support	47.5±7.6	46.9±8.6	47.9±6.9	1.03	.435^†

^†Tested using ANCOVA (controlling gender, age, and diagnosis);

^‡Tested using ANCOVA (controlling gender, age, diagnosis, and operation).

Table 3.

Logistic Analysis of Discharge Delay in Lumbar Spinal Surgery Patients Treated according to a Critical Pathway (N=170)

Variables	Categories	B	OR	95% CI	p
Gender	Female	0.97	2.63	1.40~4.94	.003
Gender	Male (reference)
Age		0.03	1.03	1.01~1.05	.008
Diagnosis	Herniated intervertebral disc (reference)
	Spinal stenosis	0.56	1.75	0.86~3.57	.125
	Spondylolisthesis	1.50	4.49	1.90~10.61	.001
Operation	Spinal fusion	1.42	4.14	1.89~9.05	＜.001
	Laminectomy	0.52	1.68	0.79~3.59	.181
	Discectomy (reference)

OR=odds ratio; CI=confidence interval.

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Factors Affecting Discharge Delay in Lumbar Spinal Surgery Patients Who were Treated according to a Critical Pathway

Korean J Adult Nurs. 2016;28(1):43-52. Published online February 29, 2016

DOI: https://doi.org/10.7475/kjan.2016.28.1.43

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Factors Affecting Discharge Delay in Lumbar Spinal Surgery Patients Who were Treated according to a Critical Pathway

Korean J Adult Nurs. 2016;28(1):43-52. Published online February 29, 2016

DOI: https://doi.org/10.7475/kjan.2016.28.1.43

Factors Affecting Discharge Delay in Lumbar Spinal Surgery Patients Who were Treated according to a Critical Pathway

Table 1.

Variables	Categories	Total (n=170)	Planned discharge (n=69)	Discharge delay (n=101)	x2 or t	p
Variables	Categories	n (%) or M±SD	n (%) or M±SD	n (%) or M±SD	x2 or t	p
Gender	Male	82 (48.2)	43 (62.3)	39 (38.6)	9.23	.003
	Female	88 (51.8)	26 (37.7)	62 (61.4)	2.62	.010
		58.9±14.8	55.1±17.1	61.4±12.5
Age (year)	≤40	24 (14.1)
	41~50	21 (12.4)
	51~60	33 (19.4)
	61~70	50 (29.4)
	≥71	42 (24.7)
Marital status	Married	144 (84.7)	58 (84.1)	86 (85.1)	0.04	.832
Marital status	Not-married	26 (15.3)	11 (15.9)	15 (14.9)
Level of education (n=169)	≤Elementary school	39 (22.9)	13 (18.8)	26 (25.7)	3.96	.265
	Middle school	45 (26.5)	15 (21.7)	30 (29.7)
	High school	36 (21.2)	18 (26.2)	18 (17.9)
	≥College	49 (28.8)	23 (33.3)	26 (25.7)
Occupation	Yes	62 (36.5)	30 (43.5)	32 (31.7)	2.46	.117
Occupation	No	108 (63.5)	39 (56.5)	69 (68.3)
Religion	Yes	103 (60.6)	41 (59.4)	62 (61.4)	0.07	.873
Religion	No	67 (39.4)	28 (40.6)	39 (38.6)
Diagnosis	Herniated intervertebral disc	62 (36.5)	34 (49.3)	28 (27.7)	12.49	.002
	Lumbar stenosis	61 (35.9)	25 (36.2)	36 (35.6)
	Spondylolisthesis	47 (27.6)	10 (14.5)	37 (36.6)
Operation	Fusion	60 (35.3)	14 (20.3)	46 (45.5)	13.32	.001
	Laminectomy	49 (28.8)	21 (30.4)	28 (27.7)
	Discectomy	61 (35.9)	34 (49.3)	27 (26.7)
Motor dysfunction at admission	Yes	20 (11.8)	9 (13.0)	11 (10.9)	0.18	.809
Motor dysfunction at admission	No	150 (88.2)	60 (87.0)	90 (89.1)
Sensory dysfunction at admission	Yes	170 (100.0)
Sensory dysfunction at admission
Comorbidity	No	72 (42.4)	33 (47.8)	39 (38.6)	1.43	.233
	Yes	98 (57.6)	36 (52.2)	62 (61.4)
	Cardiovascular disease	75 (44.1)
	Endocrinologic disease	8 (4.7)
	Neurologic disease	4 (2.4)
	Urinary disease	4 (2.4)
	Others	7 (4.1)
Experience of admission	Yes	104 (61.2)	46 (66.7)	58 (57.4)	1.47	.225
Experience of admission	No	66 (38.8)	23 (33.3)	43 (42.6)
Experience of operation	Yes	101 (59.4)	44 (63.8)	57 (56.4)	0.91	.427
Experience of operation	No	69 (40.6)	25 (36.2)	44 (43.6)
Discharge delay				1.1±0.9
	Fusion			1.1±0.8
	Laminectomy			1.3±1.4
		Discectomy			0.8±1.1

Table 2.

Comparison of Physical and Psychosocial Characteristics Between the Planned Discharge Group and the Discharge Delay Group (N=170)

Variables	Categories	Total (n=170)	Planned discharge (n=69)	Discharge delay (n=101)	z or F	p
Variables	Categories	n (%) or M±SD	n (%) or M±SD	n (%) or M±SD	z or F	p
Physical characteristics	Physical function	50.6±16.5	48.5±16.5	52.0±16.3	0.82	.804^†
	Pain
	Pain score at admission	5.8±1.8	5.4±1.6	6.0±1.8	0.87	.594^†
	Mean pain score during	2.9±1.1	2.6±1.1	3.0±1.0	2.00	.051^‡
	hospitalization
	Worst pain score during	5.7±1.8	5.1±1.7	6.1±1.9	1.59	.106^‡
	hospitalization
	Pain score at discharge	1.4±1.0	1.2±0.9	1.5±1.0	1.51	.189^‡
Psychosocial characteristics	Depression	11.2±10.6	9.1±8.5	12.6±11.7	0.74	.878^†
	Type D personality
	Type D	38 (22.4)	14 (20.3)	20 (19.8)	0.29	.708
	Non-type D	132 (77.6)	55 (79.7)	68 (67.3)
	Family support	47.5±7.6	46.9±8.6	47.9±6.9	1.03	.435^†

^†Tested using ANCOVA (controlling gender, age, and diagnosis);

^‡Tested using ANCOVA (controlling gender, age, diagnosis, and operation).

Table 3.

Logistic Analysis of Discharge Delay in Lumbar Spinal Surgery Patients Treated according to a Critical Pathway (N=170)

Variables	Categories	B	OR	95% CI	p
Gender	Female	0.97	2.63	1.40~4.94	.003
Gender	Male (reference)
Age		0.03	1.03	1.01~1.05	.008
Diagnosis	Herniated intervertebral disc (reference)
	Spinal stenosis	0.56	1.75	0.86~3.57	.125
	Spondylolisthesis	1.50	4.49	1.90~10.61	.001
Operation	Spinal fusion	1.42	4.14	1.89~9.05	＜.001
	Laminectomy	0.52	1.68	0.79~3.59	.181
	Discectomy (reference)

OR=odds ratio; CI=confidence interval.

Table 1. Comparison of Demographic and Clinical Characteristics Between the Planned Discharge Group and the Discharge Delay Group in Lumbar Spinal Surgery Patients Treated According to a Critical Pathway (N=170)

Table 2. Comparison of Physical and Psychosocial Characteristics Between the Planned Discharge Group and the Discharge Delay Group (N=170)

†

Tested using ANCOVA (controlling gender, age, and diagnosis);

‡

Tested using ANCOVA (controlling gender, age, diagnosis, and operation).

Table 3. Logistic Analysis of Discharge Delay in Lumbar Spinal Surgery Patients Treated according to a Critical Pathway (N=170)

OR=odds ratio; CI=confidence interval.

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