Independent Associations With 30- and 90-Day Unplanned Readmissions After Elective Lumbar Spine Surgery: A National Trend Analysis of 144 123 Patients

Elsamadicy, Aladine A.; Ren, Xinru; Kemeny, Hanna; Charalambous, Lefko T; Sergesketter, Amanda R.; Rahimpour, Shervin; Williamson, Theresa; Goodwin, C. Rory; Abd-El-Barr, Muhammad M.; Gottfried, Oren N.; Xie, Jichun; Lad, Shivanand P.

doi:10.1093/neuros/nyy215

Cited by 21 publications

(35 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The occurrence and duration of anemia (how long a patient spent at a given Hb level; iron deficiency) is likely as important as or may be more important than the level of anemia. Any degree of preoperative anemia and the application of blood transfusion may be associated with increased length of hospital stay and EHR after controlling for other variables [14,[26][27][28]. Moreover, valuable intraoperative characteristics such as the existence of acute blood loss, intra-or postoperative hypotension, and electrocardiographic changes may influence treatment outcomes [29,30].…”

Section: Discussionmentioning

confidence: 99%

The Effect of Discharging Patients with Low Hemoglobin Levels on Hospital Readmission and Quality of Life after Adult Spinal Deformity Surgery

et al. 2022

View full text Add to dashboard Cite

This study aims to evaluate the impact of anemia on functional outcomes, health-related quality of life (HRQoL), and early hospital readmission (EHR) rates after adult spinal deformity (ASD) surgery at the time of discharge from the hospital. Overview of Literature: Concerns with risks of transfusion, insufficient evidence for its benefits, and the possibility of associated adverse outcomes have led to restrictive transfusion practices. Therefore, patients are discharged according to patient blood management programs that are implemented in hospitals nationwide to reduce unnecessary blood transfusions. However, not many comprehensive kinds of studies exist on the effect of postoperative anemia on functional life and complications. Methods: Anemia severity was defined following the 2011 World Health Organization guidelines. All patients had HRQoL tests as well as complete blood counts pre-and postoperatively. EHR is the admission within 30 days of discharge and was used as the dependent parameter. Results: This study comprised 225 surgically treated ASD patients with a median age of 62.0 years, predominantly women (80%). Of the 225 patients, 82, 137, and six had mild, moderate, and severe anemia at the time of discharge, respectively. Seventeen of the patients (mild [11, 64.7%]; moderate [5, 29.4%]; severe [1, 5.9%]) were readmitted within 30 days. The mean hemoglobin values were higher in readmitted patients (p=0.071). Infection was the leading cause of readmission (n=12), but a low hemoglobin level was not observed in any of these patients at the time of discharge. Except for Scoliosis Research Society-22 questionnaire, HRQoL improvements did not reach statistical significance in early readmitted patients in the first year after surgery.

show abstract

Section: Discussionmentioning

confidence: 99%

The Effect of Discharging Patients with Low Hemoglobin Levels on Hospital Readmission and Quality of Life after Adult Spinal Deformity Surgery

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Age, insurance status, COPD, depression, hypertension, diabetes, deficiency anemia, and obesity were all associated with 30-day readmission and the same, except for age and obesity, were associated with 90-day readmission. 3 Chen et al identified over 265,000 lumbar spine surgery patients in the State Inpatient Databases (SID) Healthcare Cost and Utilization Project (HCUP), finding a 7.5% 30-day and an 11.5% 90-day readmission rate, associated with African American race and nonprivate insurance or self-pay, but not median household income. 11 Sivaganesan et al 12 utilized the QOD in an effort to create a predictive model for 90-day readmissions after lumbar surgery.…”

Section: Discussionmentioning

confidence: 99%

“…1 Starting in 2010, the Hospital Readmissions Reductions Program, a product of the Affordable Care Act, has penalized hospitals for certain unplanned readmissions within 30 days of discharge. 2 Recent research aimed at identifying risk factors for early readmission after elective spine surgery has used national databases, including the National Readmission Database (NRD) 3,4 and the Quality Outcomes Database (QOD). 5,6 While these data sets contain a large amount of information, they may lack granularity compared with single-center data sets, limiting the conclusions that can be drawn from these studies.…”

mentioning

confidence: 99%

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

Wiley¹,

Carreon²,

Djurasovic³

et al. 2021

Journal of Neurosurgery: Spine

View full text Add to dashboard Cite

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.

show abstract

“…Pugely et al [12] observed that the predictors of readmission after lumbar spine surgery included advanced patient age ≥80 years, African American race, recent weight loss, chronic obstructive pulmonary disorder, history of cancer, creatinine levels ≥1.2, high ASA class, operative time >4 hours, and prolonged hospital stay for more than 4 days. In 2018, Elsamadicy et al [22] reported that insurance status, having chronic obstructive pulmonary disorder, depression, hypertension, diabetes, obesity, or deficiency anemia were independently associated with 90-day readmissions following elective spine surgery. Readmissions in our series showed a statistically significant association with prolonged hospital stay (≥10 days) (p<0.001), health insurance (p=0.007), comorbid illnesses (diabetes [p=0.035], hypertension [p=0.001], and liver disease [p<0.001]) in accordance with the above-mentioned literature ( Table 5).…”

Section: Discussionmentioning

confidence: 99%

Unplanned Readmissions after Spine Surgery: A Single-Center Prospective Analysis of a 90-Day Model in 2,860 Cases

Avinash¹,

Renjith²,

Shetty³

et al. 2020

Asian Spine J

View full text Add to dashboard Cite

During the last decades, an emergence of unplanned readmissions has been shown to be a useful tool to gage the healthcare quality and hospital performance. Previous studies were limited by their retrospective designs based on database information and short-term 30-day follow-up intervals. We analyzed the incidence and causes for unplanned readmissions following spine surgery at a 90-day interval and the difference at 30-, 31-60-, and 61-90-day intervals after discharge. Additionally, we assessed total beddays lost and the economic impact of readmissions and probable risk factors. Overview of Literature: Recent reports on readmission rates suggested the contribution of this parameter for the assessment of healthcare quality. Methods: A prospective analysis of 2,860 admissions was performed over 1 year in a tertiary care orthopedic hospital. All unscheduled readmissions following spine surgery within 90 days of discharge were included, irrespective of type or location of surgery. Polytrauma, primary osseous infections, and planned readmissions were excluded. Results: Our readmission rate was 3.32% (95/2,860). Leading readmission causes were surgical site infections (SSIs) accounting for 44.21% (n=42; superficial, 23; deep, 11; organ and space, 8), followed by aseptic pain 31.58% (n=30) and medical causes 13.68% (n=13). Though 86.95% of superficial SSIs occurred within 30 days, 21.1% of deep SSIs occurred beyond 30 days. During the 30-90-day interval, 33.68% of readmissions occurred. The financial burden amounted to 41,93,660 Indian Rupees, and the mean bed-days lost was 7.33 per readmission. Hospital stay ≥10 days, health insurance, and comorbid illnesses (diabetes, hypertension, and liver disease) were associated with readmissions (p<0.05). Conclusions: Our study showed that SSIs and aseptic pain were the leading causes of readmissions at 90 days after spine surgery. Limiting the analysis to 30-day readmissions as in previous studies would lead to failure in the identification of more severe complications like deep SSIs. Continued vigilance, particularly for patients with predisposing factors, could help alleviate the financial burden.

show abstract

Independent Associations With 30- and 90-Day Unplanned Readmissions After Elective Lumbar Spine Surgery: A National Trend Analysis of 144 123 Patients

Cited by 21 publications

References 34 publications

The Effect of Discharging Patients with Low Hemoglobin Levels on Hospital Readmission and Quality of Life after Adult Spinal Deformity Surgery

The Effect of Discharging Patients with Low Hemoglobin Levels on Hospital Readmission and Quality of Life after Adult Spinal Deformity Surgery

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

Unplanned Readmissions after Spine Surgery: A Single-Center Prospective Analysis of a 90-Day Model in 2,860 Cases

Contact Info

Product

Resources

About