Factors Associated With Extended Length of Stay and 90-Day Readmission Rates Following ACDF

Abstract

Study Design: Retrospective. Objective: Identify patient risk factors for extended length of stay (LOS) and 90-day hospital readmissions following elective anterior cervical discectomy and fusion (ACDF). Methods: Included ACDF patients from 2013 to 2017 at a single institution. Eligible patients were subset into LOS <2 and LOS ≥2 days, and no 90-day hospital readmission and yes 90-day hospital readmission. Patient and surgical factors were compared between the LOS and readmission groups. Multivariable logistic regression analysis was utilized to determine the association of independent factors with LOS and 90-day readmission rates. Results: Our sample included 1896 patients; 265 (14%) had LOS ≥2 days, and 121 (6.4%) had a readmission within 90 days of surgery. Patient and surgical factors associated with LOS included patient age ≥65 years (odds ratio [OR] 1.72, 95% confidence interval [CI] 1.15-2.56), marriage (OR 0.57, 95% CI 0.43-0.79), private health insurance (OR 0.28, 95% CI 0.15-0.50), American Society of Anesthesiologists (ASA) score (OR 1.52, 95% CI 1.12-1.86), African American race (OR 1.95, 95% CI 1.38-2.72), and harvesting iliac crest autograft (OR 4.94, 95% CI 2.31-10.8). Patient and surgical factors associated with 90-day hospital readmission included ASA score (OR 1.81, 95% CI 1.32-2.49), length of surgery (OR 1.002, 95% CI 1.001-1.004), and radiculopathy as indication for surgery (OR 0.60, 95% CI 0.39-0.96). Conclusions: Extended LOS and 90-day hospital readmissions may lead to poorer patient outcomes and increased episode of care costs. Our study identified patient and surgical factors associated with extended LOS and 90-day readmission rates. In general, preoperative patient factors affected these outcomes more than surgical factors.

Disease-dependent variations in the timing and causes of readmissions in Germany: A claims data analysis for six different conditions

“…Whereas in many other countries the knowledge on readmissions for different conditions and populations is continuously increasing (e.g. [15][16][17][18][19][20][21]), comparatively little efforts were dedicated to research on readmissions in Germany, the largest European healthcare system, and information on the usability of claims data is particularly limited. Nonetheless, there are conditions of high economical and clinical importance for Germany, generating a high proportion of hospital admissions: The diagnosis of heart failure, for example, was the most frequent discharge diagnosis in German hospitals in 2016, 2017, and 2018 [22].…”

Variations in LOS and its main determinants overtime at an academic spinal care center from 2006–2019

“…Age has been reported as a key determinant of prolonged LOS in the literature [ 1 , 4 , 7 , 10 , 23 – 25 ]. This study demonstrated that elderly patients represent an increasing proportion of those receiving spine surgery.…”

The Impact of Household Economics on Short-Term Outcomes in a Posterior Fossa Tumor Population

“…The criteria selected for this study were based on supporting literature indicating the relationship of each characteristic with post-surgical outcomes. Numerous studies have demonstrated race [ 22 ], smoking status [ 23 ], BMI [ 24 - 25 ], CCI [ 26 - 28 ], duration of surgery [ 29 ], and ASA score [ 30 ] to independently predict morbidity following surgery. This study is of further value to the literature as the influence of SES on outcomes has never been independently evaluated in a posterior fossa brain tumor population.…”