Patient Body Mass Index is an Independent Predictor of 30-Day Hospital Readmission After Elective Spine Surgery

Elsamadicy, Aladine A.; Adogwa, Owoicho; Vuong, Victoria D.; Mehta, Ankit I.; Vasquez, Raul A.; Cheng, Joseph; Karikari, Isaac O.; Bagley, Carlos A.

doi:10.1016/j.wneu.2016.08.097

Cited by 46 publications

(30 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…36 Others reporting that high BMI is an independent predictor of 30-day hospital readmission after elective spine surgery. 35 Certainly, in our series, 10 of the 14 readmitted were classed as obese suggesting a causal link between obesity and 30-day readmission in our series.…”

Section: Complications Resulting 30-day Readmissionmentioning

confidence: 50%

“…In the five patients in our series who presented with a CSF leak postoperatively, three had a BMI greater than 30 kg/m 2 and all were open skull base procedures. Certainly, some case series suggest that BMI is an independent predictor of 30-day readmission following spinal 35 and cranial 36 surgery. Should we therefore anticipate a CSF leak in obese patients undergoing skull base procedures?…”

Section: Complications Resulting 30-day Readmissionmentioning

confidence: 99%

See 1 more Smart Citation

Smoking and Obesity are Risk Factors for Thirty-Day Readmissions Following Skull Base Surgery

et al. 2019

View full text Add to dashboard Cite

Background Thirty-day readmission has become a significant health care metric reflecting the quality of care and on the cost of service delivery. There is little data on the impact of complications following skull base surgery (SBS) on emergency readmission. Identifying modifiable risk factors for readmission may improve care and reduce cost. Design The study was designed as a single-center retrospective cohort study. Methods Records for a consecutive series of 165 patients who underwent open or endoscopic SBS by a single surgeon reviewed. Patients with pituitary adenoma were excluded. The diagnosis, procedure, complications, length of stay (LOS), body mass index (BMI), and smoking status were recorded. Readmission to the neurosurgical department or regional hospitals was either noted prospectively or the patient contacted. Cause and length of readmission was documented. Results Of the 165 cases, 14 (8.5%) were readmitted within 30 days. Causes for readmission included cerebrospinal fluid (CSF) leak in 5/14 or 35.7% (overall rate for readmission for this complication in the series is 3.1%), infection in 4/14 (28.6%), hyponatraemia in 2/14 (14.3%), vascular: sinus thrombosis in 1/14 (7.1%), seizures in 1/14 (7.1%), and epistaxis in 1/14 (7.1%). Initial and readmission LOS was 6 and 14 days, respectively. BMI was higher in those readmitted within 30 days (33.2 kg/m2) versus no readmission (27.1 kg/m2). In addition, of those readmitted within 30 days, 35.7% were smokers compared with 20.8% in those not readmitted. Conclusion In this series, smoking and raised BMI may be indicators for within 30-day readmission and complications in this population, raising the question of risk factor modification prior to elective intervention.

show abstract

Section: Complications Resulting 30-day Readmissionmentioning

confidence: 50%

Section: Complications Resulting 30-day Readmissionmentioning

confidence: 99%

Smoking and Obesity are Risk Factors for Thirty-Day Readmissions Following Skull Base Surgery

et al. 2019

View full text Add to dashboard Cite

show abstract

“…In addition to mechanical complications, high BMI has been linked with increased postoperative infections after spinal surgery (25)(26)(27)(28). Both of these complications contribute to the association between obesity and increased 30-day readmission rates seen both in the spine surgery literature (29)(30)(31) and in our study. Owing to the increasing number of obese patients suffering from chronic pain syndrome and undergoing SCS implantation, these risks warrant consideration in the preoperative setting (23).…”

Section: Discussionsupporting

confidence: 55%

Drivers and Risk Factors of Unplanned 30-Day Readmission Following Spinal Cord Stimulator Implantation

Elsamadicy

Sergesketter

Ren

et al. 2018

Neuromodulation: Technology at the Neural Interface

Self Cite

View full text Add to dashboard Cite

Our study suggests that infectious and mechanical complications are the primary drivers of unplanned 30-day readmission after SCS implantation, with obesity as an independent predictor of unplanned readmission. Given the technological advancements in SCS, repeated studies are necessary to identify factors associated with unplanned 30-day readmission rates after SCS implantation to improve patient outcomes and reduce associated costs.

show abstract

“…"Thirty-day all-cause readmissions" were defined as any repeat hospitalization, regardless of cause, within 30 days of discharge from the index visit, as is concordant with previous definitions in the literature. 8,11 Revision fusion was a binary variable representing the presence of any subsequent lumbar fusion (using the same ICD-9 and CPT codes used to define the original procedure) within the coverage period. Similarly, discharge home was a binary variable indicating whether the patient was discharged to home after the initial fusion surgery (rather than to a skilled nursing or rehabilitation facility, hospice, and so forth), which is coded as a categorical variable in the MarketScan database representing location of discharge.…”

Section: Discussionmentioning

confidence: 99%

Preoperative depression, lumbar fusion, and opioid use: an assessment of postoperative prescription, quality, and economic outcomes

O’Connell

Azad²,

Mittal

et al. 2018

Neurosurgical Focus

View full text Add to dashboard Cite

OBJECTIVEPreoperative depression has been linked to a variety of adverse outcomes following lumbar fusion, including increased pain, disability, and 30-day readmission rates. The goal of the present study was to determine whether preoperative depression is associated with increased narcotic use following lumbar fusion. Moreover, the authors examined the association between preoperative depression and a variety of secondary quality indicator and economic outcomes, including complications, 30-day readmissions, revision surgeries, likelihood of discharge home, and 1- and 2-year costs.METHODSA retrospective analysis was conducted using a national longitudinal administrative database (MarketScan) containing diagnostic and reimbursement data on patients with a variety of private insurance providers and Medicare for the period from 2007 to 2014. Multivariable logistic and negative binomial regressions were performed to assess the relationship between preoperative depression and the primary postoperative opioid use outcomes while controlling for demographic, comorbidity, and preoperative prescription drug–use variables. Logistic and log-linear regressions were also used to evaluate the association between depression and the secondary outcomes of complications, 30-day readmissions, revisions, likelihood of discharge home, and 1- and 2-year costs.RESULTSThe authors identified 60,597 patients who had undergone lumbar fusion and met the study inclusion criteria, 4985 of whom also had a preoperative diagnosis of depression and 21,905 of whom had a diagnosis of spondylolisthesis at the time of surgery. A preoperative depression diagnosis was associated with increased cumulative opioid use (β = 0.25, p < 0.001), an increased risk of chronic use (OR 1.28, 95% CI 1.17–1.40), and a decreased probability of opioid cessation (OR 0.96, 95% CI 0.95–0.98) following lumbar fusion. In terms of secondary outcomes, preoperative depression was also associated with a slightly increased risk of complications (OR 1.14, 95% CI 1.03–1.25), revision fusions (OR 1.15, 95% CI 1.05–1.26), and 30-day readmissions (OR 1.19, 95% CI 1.04–1.36), although it was not significantly associated with the probability of discharge to home (OR 0.92, 95% CI 0.84–1.01). Preoperative depression also resulted in increased costs at 1 (β = 0.06, p < 0.001) and 2 (β = 0.09, p < 0.001) years postoperatively.CONCLUSIONSAlthough these findings must be interpreted in the context of the limitations inherent to retrospective studies utilizing administrative data, they provide additional evidence for the link between a preoperative diagnosis of depression and adverse outcomes, particularly increased opioid use, following lumbar fusion.

show abstract

Patient Body Mass Index is an Independent Predictor of 30-Day Hospital Readmission After Elective Spine Surgery

Cited by 46 publications

References 14 publications

Smoking and Obesity are Risk Factors for Thirty-Day Readmissions Following Skull Base Surgery

Smoking and Obesity are Risk Factors for Thirty-Day Readmissions Following Skull Base Surgery

Drivers and Risk Factors of Unplanned 30-Day Readmission Following Spinal Cord Stimulator Implantation

Preoperative depression, lumbar fusion, and opioid use: an assessment of postoperative prescription, quality, and economic outcomes

Contact Info

Product

Resources

About