Predictors of unplanned readmission in patients undergoing lumbar decompression: multi-institutional analysis of 7016 patients

Kim, Bobby D.; Smith, Timothy R.; Lim, Seokchun; Cybulski, George R.; Kim, John Y.S.

doi:10.3171/2014.3.spine13699

Cited by 100 publications

(101 citation statements)

References 68 publications

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“…We recommend that future studies examine the benefits of close monitoring and rigorous followup on the readmission rate of patients with extended lengths of stay. The correlation of ASA score to increased 30-day readmissions aligns with results reported in the orthopaedic spine literature [3,16,23,25]. We believe that an increased ASA score aligns with increased comorbidities, thus increasing the likelihood of 30-day readmission.…”

Section: Discussionsupporting

confidence: 86%

What Are the 30-day Readmission Rates Across Orthopaedic Subspecialties?

Bernatz

Tueting

Hetzel

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background The Centers for Medicare & Medicaid Services (CMS) now include hip and knee replacements in the Hospital Readmission Reduction Program. The 30-day readmission rate is an important quality metric; however, the incidence has not yet been defined across the numerous orthopaedic subspecialties. Elucidating the readmission rate for each subspecialty may indicate that certain services are being disincentivized by the CMS reimbursement program.

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Section: Discussionsupporting

confidence: 86%

What Are the 30-day Readmission Rates Across Orthopaedic Subspecialties?

Bernatz

Tueting

Hetzel

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…Although the present study illustrates the effects that age, ASA grade, body habitus, and durotomies can have on hospital costs and length of stay, it reflects solely the immediate perioperative period. It is probable that these individual factors lead to increased complications and readmissions, as recently demonstrated in 2 independent studies conducted by Whitmore et al 18 and Kim et al 8 In addition, this study does not factor in long-term outcomes, which are equally important to consider and review in the subsets when considering reimbursement for surgery, as each cohort will probably still benefit. 1,5,12 The advantages of this study compared with large inpatient samples are the uniformity in practice and the accuracy of data collection.…”

Section: Discussionmentioning

confidence: 94%

Patient-specific factors affecting hospital costs in lumbar spine surgery

Puffer¹,

Planchard²,

Mallory³

et al. 2016

SPI

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OBJECT Health care-related costs after lumbar spine surgery vary depending on procedure type and patient characteristics. Age, body mass index (BMI), number of spinal levels, and presence of comorbidities probably have significant effects on overall costs. The present study assessed the impact of patient characteristics on hospital costs in patients undergoing elective lumbar decompressive spine surgery. METHODS This study was a retrospective review of elective lumbar decompression surgeries, with a focus on specific patient characteristics to determine which factors drive postoperative, hospital-related costs. Records between January 2010 and July 2012 were searched retrospectively. Only elective lumbar decompressions including discectomy or laminectomy were included. Cost data were obtained using a database that allows standardization of a list of hospital costs to the fiscal year 2013–2014. The relationship between cost and patient factors including age, BMI, and American Society of Anesthesiologists (ASA) Physical Status Classification System grade were analyzed using Student t-tests, ANOVA, and multivariate regression analyses. RESULTS There were 1201 patients included in the analysis, with a mean age of 61.6 years. Sixty percent of patients in the study were male. Laminectomies were performed in 557 patients (46%) and discectomies in 644 (54%). Laminectomies led to an increased hospital stay of 1.4 days (p < 0.001) and increased hospital costs by $1523 (p < 0.001) when compared with discectomies. For laminectomies, age, BMI, ASA grade, number of levels, and durotomy all led to significantly increased hospital costs and length of stay on univariate analysis, but ASA grade and presence of a durotomy did not maintain significance on multivariate analysis for hospital costs. For a laminectomy, patient age ≥ 65 years was associated with a 0.6-day increased length of stay and a $945 increase in hospital costs when compared with patient age < 65 years (p < 0.001). A durotomy during a laminectomy increased length of stay by 1.0 day and increased hospital costs by $1382 (p < 0.03). For discectomies, age, ASA grade, and durotomy were significantly associated with increased hospital costs on univariate analysis, but BMI was not. Only age and presence of a durotomy maintained significance on multivariate analysis. There was a significant increase in hospital length of stay in patients undergoing discectomy with increasing age, BMI, ASA grade, and presence of a durotomy on univariate analysis. However, only age and presence of a durotomy maintained significance on multivariate analysis. For discectomies, age ≥ 65 years was associated with a 0.7-day increased length of stay (p < 0.001) and an increase of $931 in postoperative hospital costs (p < 0.01) when compared with age < 65 years. CONCLUSIONS Patient factors such as age, BMI, and comorbidities have significant and measurable effects on the postoperative hospital costs of elective lumbar decompression spinal surgeries. Knowledge of how these factors affect costs will become important as reimbursement models change.

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“…All of the selected studies assessed readmission rates and compared readmitted and nonreadmitted patients 21,24,30 or the readmitted and overall patient population 8,19 and identified vulnerable populations and evaluated risk factors for readmission after neurosurgery of the spine. Investigated procedures included lumbar decompression, discectomy, laminectomy, and fusion 8,21,30 and anterior cervical discectomy and fusion and corpectomy.…”

Section: Resultsmentioning

confidence: 99%

Causes of 30-day readmission after neurosurgery of the spine

Cusimano

Pshonyak

Lee

et al. 2016

SPI

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OBJECT Thirty-day readmission has been cited as an important indicator of the quality of care in several fields of medicine. The aim of this systematic review was to examine rate of readmission and factors relevant to readmission after neurosurgery of the spine. METHODS The authors carried out a systematic review using several databases, searches of cited reference lists, and a manual search of the JNS Publishing Group journals (Journal of Neurosurgery; Journal of Neurosurgery: Spine; Journal of Neurosurgery: Pediatrics; and Neurosurgical Focus), Neurosurgery, Acta Neurochirurgica, and Canadian Journal of Neurological Sciences. A quality review was performed using STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) criteria and reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RESULTS A systematic review of 1136 records published between 1947 and 2014 revealed 31 potentially eligible studies, and 5 studies met inclusion criteria for content and quality. Readmission rates varied from 2.54% to 14.7%. Sequelae that could be traced back to complications that arose during neurosurgery of the spine were a prime reason for readmission after discharge. Increasing age, poor physical status, and comorbid illnesses were also important risk factors for 30-day readmission. CONCLUSIONS Readmission rates have predictable factors that can be addressed. Strategies to reduce readmission that relate to patient-centered factors, complication avoidance during neurosurgery, standardization with system-wide protocols, and moving toward a culture of nonpunitive system-wide error and “near miss” investigations and quality improvement are discussed.

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Predictors of unplanned readmission in patients undergoing lumbar decompression: multi-institutional analysis of 7016 patients

Abstract: There were several risk factors for UR after lumbar spine decompression surgery. Identification of high-risk patients and appropriate allocation of resources to reduce postoperative incidence may reduce the readmission rate.

Cited by 100 publications

References 68 publications

What Are the 30-day Readmission Rates Across Orthopaedic Subspecialties?

What Are the 30-day Readmission Rates Across Orthopaedic Subspecialties?

Patient-specific factors affecting hospital costs in lumbar spine surgery

Causes of 30-day readmission after neurosurgery of the spine

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