Readmission Rate After 2-level Lumbar Decompression

Abstract

Study Design: Retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database years 2012–2015. Objective: Compare the 30-day readmission and postoperative major complications rates of 2-level lumbar decompression performed in the ambulatory and the inpatient settings. Summary of Background Data: In recent years, there is an increasing trend toward ambulatory spine surgery. However, there remains a concern regarding risks of readmission and postoperative morbidity after discharge. Methods: The ACS-NSQIP database from 2012 to 2015 was queried for adult patients who underwent elective 2-level lumbar decompression (CPT code 63047 accompanied with code 63048). A cohort of ambulatory lumbar decompression cases was matched 1:1 with an inpatient cohort after controlling for patient demographics, comorbidities, and complexity of the procedure. The primary outcome was the 30-day readmission rate. Secondary outcomes included a composite of 30-day postoperative major complications and hospital length of stay for hospitalized patients. Results: A total of 7505 patients met our study criteria. The ambulatory 2-level lumbar decompression surgery rate increased significantly over the study period from 28% in 2012 to 49% in 2015 (P<0.001). In the matched sample, there was no statistically significant difference in the 30-day readmission rate (odds ratio, 0.82; 95% confidence interval, 0.64–1.04; P=0.097) between the two cohorts; however, the ambulatory cohort had a lower 30-day postoperative major complication rate (odds ratio, 0.55; 95% confidence interval, 0.38–0.79; P=0.002). Conclusions: After 2-level lumbar decompression performed on inpatient versus outpatient basis, the 30-day readmission rate is similar. However, the 30-day postoperative complication rate is significantly lower in the ambulatory setting. The reasons for these differences need further exploration. Level of Evidence: Level III.

Risk Factors for 30-day and 90-day Readmission After Lumbar Decompression

“…The overall readmission rate for patients undergoing elective isolated lumbar decompression in our study was at or below the rate previously reported in literature 52–59 . However, readmission data in large databases such as NSQIP often lack granularity with regard to the cause of readmission and such classification is subject to the clinical reviewer for each hospital 60 .…”

“…[48][49][50][51] The overall readmission rate for patients undergoing elective isolated lumbar decompression in our study was at or below the rate previously reported in literature. [52][53][54][55][56][57][58][59] However, readmission data in large databases such as NSQIP often lack granularity with regard to the cause of readmission and such classification is subject to the clinical reviewer for each hospital. 60 As such, surgically related readmission rates of large databases may be inflated and percentages may better reflect an all-cause readmission rate.…”

Pain management after laminectomy: a systematic review and procedure-specific post-operative pain management (prospect) recommendations

“…These procedures are increasingly performed in an ambulatory or day-care setting. Inadequate pain management is one of the main reasons for delayed discharge or readmission after surgery [1,4]. Effective pain control improves post-operative outcomes and patient satisfaction.…”