Risk Factors Associated With 30-day Readmissions After Instrumented Spine Surgery in 14,939 Patients

Akins, Paul T.; Harris, Jessica; Alvarez, Julie L.; Chen, Yuexin; Paxton, Elizabeth W.; Bernbeck, Johannes A.; Guppy, Kern H.

doi:10.1097/brs.0000000000000916

Cited by 107 publications

(54 citation statements)

References 21 publications

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“…5,32 In our study, the diagnosis of lung cancer and hospital stay longer than 15 days during the index hospitalization were independently associated with 90-day readmission, which is consistent with prior studies as well. 6 Other previously identified risk factors for readmission following spine surgery include malignancy, longer operative time, longer constructs, higher patient severity of illness, and surgical complications. 6,32 Over the 1-year postoperative period, the most common cause for readmission after spinal tumor surgery is tumor recurrence (33% of readmissions).…”

Section: Discussionmentioning

confidence: 99%

“…6 Other previously identified risk factors for readmission following spine surgery include malignancy, longer operative time, longer constructs, higher patient severity of illness, and surgical complications. 6,32 Over the 1-year postoperative period, the most common cause for readmission after spinal tumor surgery is tumor recurrence (33% of readmissions). 33 Specifically, aggressive metastatic spinal tumors (lung, osteosarcoma, stomach, bladder, esophagus, and pancreas) and the presence of medical comorbidities increased the risk for readmission.…”

Section: Discussionmentioning

confidence: 99%

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Costs and readmission rates for the resection of primary and metastatic spinal tumors: a comparative analysis of 181 patients

Lau¹,

Chan²,

Theologis

et al. 2016

SPI

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OBJECTIVE Because the surgical strategies for primary and metastatic spinal tumors are different, the respective associated costs and morbidities associated with those treatments likely vary. This study compares the direct costs and 90-day readmission rates between the resection of extradural metastatic and primary spinal tumors. The factors associated with cost and readmission are identified. METHODS Adults (age 18 years or older) who underwent the resection of spinal tumors between 2008 and 2013 were included in the study. Patients with intradural tumors were excluded. The direct costs of index hospitalization and 90-day readmission hospitalization were evaluated. The direct costs were compared between patients who were treated surgically for primary and metastatic spinal tumors. The independent factors associated with costs and readmissions were identified using multivariate analysis. RESULTS A total of 181 patients with spinal tumors were included (63 primary and 118 metastatic tumors). Overall, the mean index hospital admission cost for the surgical management of spinal tumors was $52,083. There was no significant difference in the cost of hospitalization between primary ($55,801) and metastatic ($50,098) tumors (p = 0.426). The independent factors associated with higher cost were male sex (p = 0.032), preoperative inability to ambulate (p = 0.002), having more than 3 comorbidities (p = 0.037), undergoing corpectomy (p = 0.021), instrumentation greater than 7 levels (p < 0.001), combined anterior-posterior approach (p < 0.001), presence of a perioperative complication (p < 0.001), and longer hospital stay (p < 0.001). The perioperative complication rate was 21.0%. Of this cohort, 11.6% of patients were readmitted within 90 days, and the mean hospitalization cost of that readmission was $20,078. Readmission rates after surgical treatment for primary and metastatic tumors were similar (11.1% vs 11.9%, respectively) (p = 0.880). Prior hospital stay greater than 15 days (OR 6.62, p = 0.016) and diagnosis of lung metastasis (OR 52.99, p = 0.007) were independent predictors of readmission. CONCLUSIONS Primary and metastatic spinal tumors are comparable with regard to the direct costs of the index surgical hospitalization and readmission rate within 90 days. The factors independently associated with costs are related to preoperative health status, type and complexity of surgery, and postoperative course.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Costs and readmission rates for the resection of primary and metastatic spinal tumors: a comparative analysis of 181 patients

Lau¹,

Chan²,

Theologis

et al. 2016

SPI

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“…The accuracy of data collection by the NSQIP (including cumulative incidence and reasons for readmission) has been externally validated, 84 and this data source has been previously used to evaluate patients undergoing neurosurgical intervention, 4,8,12,14,15,28,29,45,54,83 including spine surgery. 2,6,9,10,25,40,53,59,61,82,91 Our institutional review board has exempted the de-identified NSQIP data set from individual review.…”

Section: Data Sourcementioning

confidence: 99%

Thirty-day readmission and reoperation after surgery for spinal tumors: a National Surgical Quality Improvement Program analysis

Karhade

Vasudeva

Dasenbrock

et al. 2016

FOC

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OBJECTIVE The goal of this study was to use a large national registry to evaluate the 30-day cumulative incidence and predictors of adverse events, readmissions, and reoperations after surgery for primary and secondary spinal tumors. METHODS Data from adult patients who underwent surgery for spinal tumors (2011–2014) were extracted from the prospective National Surgical Quality Improvement Program (NSQIP) registry. Multivariable logistic regression was used to evaluate predictors of reoperation, readmission, and major complications (death, neurological, cardiopulmonary, venous thromboembolism [VTE], surgical site infection [SSI], and sepsis). Variables screened included patient age, sex, tumor location, American Society of Anesthesiologists (ASA) physical classification, preoperative functional status, comorbidities, preoperative laboratory values, case urgency, and operative time. Additional variables that were evaluated when analyzing readmission included complications during the surgical hospitalization, hospital length of stay (LOS), and discharge disposition. RESULTS Among the 2207 patients evaluated, 51.4% had extradural tumors, 36.4% had intradural extramedullary tumors, and 12.3% had intramedullary tumors. By spinal level, 20.7% were cervical lesions, 47.4% were thoracic lesions, 29.1% were lumbar lesions, and 2.8% were sacral lesions. Readmission occurred in 10.2% of patients at a median of 18 days (interquartile range [IQR] 12–23 days); the most common reasons for readmission were SSIs (23.7%), systemic infections (17.8%), VTE (12.7%), and CNS complications (11.9%). Predictors of readmission were comorbidities (dyspnea, hypertension, and anemia), disseminated cancer, preoperative steroid use, and an extended hospitalization. Reoperation occurred in 5.3% of patients at a median of 13 days (IQR 8–20 days) postoperatively and was associated with preoperative steroid use and ASA Class 4–5 designation. Major complications occurred in 14.4% of patients: the most common complications and their median time to occurrence were VTE (4.5%) at 9 days (IQR 4–19 days) postoperatively, SSIs (3.6%) at 18 days (IQR 14–25 days), and sepsis (2.9%) at 13 days (IQR 7–21 days). Predictors of major complications included dependent functional status, emergency case status, male sex, comorbidities (dyspnea, bleeding disorders, preoperative systemic inflammatory response syndrome, preoperative leukocytosis), and ASA Class 3–5 designation (p < 0.05). The median hospital LOS was 5 days (IQR 3–9 days), the 30-day mortality rate was 3.3%, and the median time to death was 20 days (IQR 12.5–26 days). CONCLUSIONS In this NSQIP analysis, 10.2% of patients undergoing surgery for spinal tumors were readmitted within 30 days, 5.3% underwent a reoperation, and 14.4% experienced a major complication. The most common complications were SSIs, systemic infections, and VTE, which often occurred late (after discharge from the surgical hospitalization). Patients were primarily readmitted for new complications that developed following discharge rather than exacerbation of complications from the surgical hospital stay. The strongest predictors of adverse events were comorbidities, preoperative steroid use, and higher ASA classification. These models can be used by surgeons to risk-stratify patients preoperatively and identify those who may benefit from increased surveillance following hospital discharge.

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Section: Preoperative Evaluation Literaturementioning

confidence: 99%

“…Akins et al [21] investigated predictors of 30-day readmission for spine surgery patients. Multivariate analyses of data from 14,939 patients found that the following factors predicted 30-day hospital readmission: presence of malignancy; longer operative time (any operation greater than 200 min in length); longer hospital stay (longer than 6 days); surgical complications (dural tear, infection, epidural hematoma); depression; rheumatoid arthritis; deficiency anemia; and hypothyroidism [21]. Bekelis et al conducted a retrospective study involving data from 13,660 patients to create a predictive model of spine surgery complications, including 30-day postoperative risk of stroke, myocardial infarction, infection, urinary tract infection (UTI), death, deep vein thrombosis (DVT), pulmonary embolism (PE), and unplanned return to surgery.…”

Section: Preoperative Evaluation Literaturementioning

confidence: 99%

Complication avoidance with pre-operative screening: insights from the Seattle spine team

Buchlak

Yanamadala

Lévêque

et al. 2016

Curr Rev Musculoskelet Med

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Complication rates for complex adult lumbar scoliosis surgery are unacceptably high. Standardized preoperative evaluation protocols have been shown to significantly reduce the likelihood of a spectrum of negative outcomes associated with complex adult lumbar scoliosis surgery. To increase patient safety and reduce complication risk, an entire medical and surgical team should work together to care for adult lumbar scoliosis patients. This article describes preoperative patient evaluation strategies with a particular focus on adult lumbar scoliosis surgery involving six or more levels of spinal fusion. Domains considered include recent preoperative evaluation literature, predictive risk modeling, the appropriate management of medical conditions, and the composition and activities of a multidisciplinary conference review team. An evidence-based comprehensive systematic preoperative surgical evaluation process is described.

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Risk Factors Associated With 30-day Readmissions After Instrumented Spine Surgery in 14,939 Patients

Abstract: 3.

Cited by 107 publications

References 21 publications

Costs and readmission rates for the resection of primary and metastatic spinal tumors: a comparative analysis of 181 patients

Costs and readmission rates for the resection of primary and metastatic spinal tumors: a comparative analysis of 181 patients

Thirty-day readmission and reoperation after surgery for spinal tumors: a National Surgical Quality Improvement Program analysis

Complication avoidance with pre-operative screening: insights from the Seattle spine team

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