Predictors of 30-Day Unplanned Readmissions, Complications, and Mortality Following Operative Management of C2 Fractures

Abstract

Study Design: Retrospective database review. Objectives: To determine factors associated with unplanned readmission, complications, and mortality in patients undergoing operative management for C2 fractures. Methods: The American College of Surgeons–National Surgical Quality Improvement Program (ACS NSQIP) was queried between 2007 and 2014. Unplanned readmission, any complication, and mortality were the outcomes of interest. Bivariate statistics were calculated, and multivariate regression models were estimated. Results: A total of 285 patients were enrolled. Readmission data was available for 199 patients and 11 patients (5.5% of 199 patients) had an unplanned readmission. Overall, 60 patients (21% of 285 patients) had at least 1 complication and 15 patients (5.3% of 285 patients) died. Five factors were associated with complications: transferred from another facility (odds ratio [OR] 3.00, 95% confidence interval [CI]1.51-5.98; P < .01); operative time ≥180 minutes (OR 2.43, 95% CI 1.11-5.36; P = .03); at least 1 patient comorbidity (OR 2.50, 95% CI 1.01-6.18; P < .05); American Society of Anesthesiologists (ASA) class 3 (OR 4.86, 95% CI 1.19-19.88; P = .03); and ASA class 4 (OR 7.24, 95% CI 1.66-31.66; P = .01). The only factor associated with unplanned readmission was having at least one postoperative complication (OR 7.10, 95% CI 1.04-48.59; P < .05), while patients who were partially or totally dependent from a functional standpoint were at increased odds of death (OR 3.98, 95% CI 1.12-14.08; P = .03). Conclusions: Patients with functional limitations have increased odds of death, while patients with postoperative complications have increased odds of unplanned readmission. Being transferred from an outside facility, having an operative time ≥180 minutes, having at least one comorbidity, and being classified as ASA class 3 or 4 increase patient odds of complication.

Predictors of hospital readmission within 30 days after surgery for thoracolumbar fractures: A mixed approach

“…The group of readmitted patients presented a lower percentage of routine discharge from hospital and higher Charlson comorbidity score, longer hospital stays, patients older than 60 years, Black and Hispanic, attended by physicians with a lower volume of spine fractures and hospital with a lower volume of patients, as well as patients having their procedures covered under Medicaid were at a higher risk compared to procedures covered by Medicare. These findings are similar to those found in other studies 18–20 …”

“…These findings are similar to those found in other studies. [18][19][20] Complications and unplanned readmission were associated with cervical fracture/dislocation surgeries, 18 solitary tumours, 21 and thoracolumbar spondylosis/stenosis. 22 In several studies, advanced age was a risk factor for 30day readmission in patients who underwent spinal surgery.…”