Economic analysis of 90-day return to the emergency room and readmission after elective lumbar spine surgery: a single-center analysis of 5444 patients

Abstract

OBJECTIVEIn the future, payers may not cover unplanned 90-day emergency room (ER) visits or readmissions after elective lumbar spine surgery. Prior studies using large administrative databases lack granularity and/or use a proxy for actual cost. The purpose of this study was to identify risk factors and subsequent costs associated with 90-day ER visits and readmissions after elective lumbar spine surgery.METHODSA prospective, multisurgeon, single-center electronic medical record was queried for elective lumbar spine fusion surgeries from 2013 to 2017. Predictive models were created for 90-day ER visits and readmissions.RESULTSOf 5444 patients, 729 (13%) returned to the ER, most often for pain (n = 213, 29%). Predictors of an ER visit were prior ER visit (OR 2.5), underserved zip code (OR 1.4), and number of chronic medical conditions (OR 1.4). In total, 421 (8%) patients were readmitted, most frequently for wound infection (n = 123, 2%), exacerbation of chronic obstructive pulmonary disease (n = 24, 0.4%), and sepsis (n = 23, 0.4%). Predictors for readmission were prior ER visit (OR 1.96), multiple chronic conditions (OR 1.69), obesity (nonobese, OR 0.49), race (African American, OR 1.43), admission status (ER admission, OR 2.29), and elevated hemoglobin A1c (OR 1.80). The mean direct hospital cost for an ER visit was $1971, with 75% of visits costing less than $1890, and the average readmission cost was $7347, with 75% of readmissions costing less than $8820. Over the 5-year study period, the cost to the institution for 90-day return ER visits was $5.1 million.CONCLUSIONSRisk factors for 90-day ER visit and readmission after elective lumbar spine surgery include medical comorbidities and socioeconomic factors. Proper patient counseling, appropriate postoperative pain management, and optimization of modifiable risk factors prior to surgery are areas to focus future efforts to lower 90-day ER visits and readmissions and reduce healthcare costs.

Outcomes With a Mobile Digital Health Platform for Patients Undergoing Spine Surgery: Retrospective Analysis

“…According to one of these centers' economic analyses, the average postoperative spine ER visit costs around US $2000, whereas the average readmission costs US $7400. [3] Given the significant economic burden, improved patient follow-up and education about medical emergencies may help minimize health care resource utilization by reducing postoperative ER visits following spine surgery. Furthermore, spine procedures are linked with high clinical morbidity.…”

“…Recent changes to the American Medicare and Medicaid insurance systems have rewarded hospitals for reducing 90-day postoperative emergency room (ER) visits and penalized them for unnecessary ER visits [ 3 ]. The rates of 90-day postoperative ER visits at 2 major medical centers were 9.4% and 13%, respectively, with postoperative discomfort being the most common reason [ 3 , 4 ]. According to one of these centers’ economic analyses, the average postoperative spine ER visit costs around US $2000, whereas the average readmission costs US $7400.…”

Surgeon Specialty Effect on Early Outcomes of Elective Posterior/Transforaminal Lumbar Interbody Fusions: An Updated Propensity-Matched and Subgroup Analysis of 13,072 Patients.

“…Although the reasons behind these differences between the two cohorts remain largely unknown and might be beyond the scope of this study, it is worth mentioning that these outcome measures might have signi cant clinical and cost implications for patients, physicians, program directors, hospitals and payors [28,37,27,1]. The higher incidence of blood transfusion among orthopedic cohort is of interest since it may represent a potentially modi able practice.…”

An analysis of 90-day emergency department visits after peripherally inserted central catheter (PICC) placement for prosthetic joint infection

“…Although this is the first study to identify race as a predictor of 90-day ED visit after PICC line placement, Plate et al 9 recently identified Black race as a predictor of 90-day ED visit after total joint arthroplasty. 9 Similarly, Wiley et al 10 identified Black race as a predictor of 90-day ED visits after lumbar spine surgery. Taken together, this data implies that age and race are important sociodemographic predictors of ED utilization after PICC-line placement.…”