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

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>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 &lt; 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).</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>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.</jats:p></jats:sec>

Thirty-day readmission and reoperation rates after single-level anterior cervical discectomy and fusion versus those after cervical disc replacement

“…However, patients with a history of COPD or hypertension and those at ASA Class IV were at higher risk of readmission, which supports the hypothesis of a sicker population and has also been found in previous investigations. 18,30 Future research specifically into shortterm outcomes of ACDF and CDR might further corroborate or challenge these findings.…”

Thirty-Day Outcomes after Surgery for Primary Sarcomas of the Extremities: An Analysis of the NSQIP Database

“…e data collection and quality control methodologies for NSQIP have been previously described and shown to be reliable [15,16]. NSQIP has been used to characterize demographics, comorbidities, and early postoperative complications for primary and metastatic bone tumors of the spine [17,18] as well as retroperitoneal sarcomas [19]. Additionally, our research team has used NSQIP to evaluate outcomes after surgical management of metastatic tumors of the extremities.…”

Thirty-Day Outcomes following Pediatric Bone and Soft Tissue Sarcoma Surgery: A NSQIP Pediatrics Analysis

“…is is 25fold higher than the thirty-day mortality rate of 0.04% for all pediatric orthopedic procedures reported to NSQIP-P in 2012 [26]. However, it is lower than the 3.3% mortality rate of adults undergoing spinal tumor resections in the adult NSQIP database between 2011 and 2014 [22]. Additionally, in our previous NSQIP study of adult bone and soft tissue sarcomas of the extremities, we found a thirty-day mortality rate of 0.4% [25].…”

“…e adult registry is well established with over six hundred participating sites across the United States and a current case volume of 6,638,405 procedures performed between 2005 and 2017. NSQIP has been used to characterize patient characteristics and outcomes after surgical management of primary and metastatic tumors of the spine [22,23]. Our research team has also used NSQIP to study outcomes after surgical management of primary bone and soft tissue sarcomas and metastatic bone tumors of the extremities [24,25].…”