Thirty-Day Readmission Risk Factors Following Single-Level Transforaminal Lumbar Interbody Fusion (TLIF) for 4992 Patients From the ACS-NSQIP Database

Abstract

Study Design:Retrospective cohort study.Objective:To describe the readmission rate and identify risk factors associated with 30-day readmission after transforaminal lumbar interbody fusion (TLIF) surgery.Methods:Patients who underwent elective single level TLIF surgery from 2011 to 2013 were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Emergency or trauma cases were excluded. Preoperative, intraoperative, and postoperative variables were extracted. A multivariate binary regression identified predictors correlated with 30-day readmission.Results:A total of 4992 patients were included in the analysis. The overall 30-day readmission rate was 5.51% (275/4992) for readmissions reported between 2011 to 2013. The mean age of patients readmitted was 62.40 years (standard error [SE] = 0.78) and 60.92 years (SE = 0.20) among those whom were not readmitted (P = .05). The top three causes for readmission included postoperative pain control, deep or superficial surgical site infections. Predictors associated with 30-day readmission in a multivariate analysis included female gender (odds ratio [OR] = 1.27, 95% CI = 0.97-1.65), history of severe chronic obstructive pulmonary disease (OR = 1.81, 95% CI = 1.11-2.96), and in the postoperative period, American Society of Anesthesiologists class (OR = 1.30, 95% CI = 1.04-1.63), presence of superficial surgical site infection (OR= 18.23, 95% CI = 10.36-32.08), or urinary tract infection (OR = 4.93, 95% CI = 2.84-8.58).Conclusions:The readmission rate, risk factors, and causes following TLIF surgery are comparable to other lumbar spinal procedures reported from the ACS-NSQIP database.

Economic Analysis of Transforaminal Lumbar Interbody Fusion Surgery Utilizing a Curved Bone Removal Device

“…The complication and readmission rates reported in the literature vary between studies. Studies on the National Surgical Quality Improvement Program (NSQIP) database found a 5.51% readmission rate within 30 days [47] and a 4% major complication rate [48], similar to Chan et al, who reported a 3.5% 3-month readmission rate [49]. These rates are relatively similar to the readmission rate calculated for the control group in the current study.…”

Thirty-Day Outcomes From Standalone Minimally Invasive Surgery-Transforaminal Lumbar Interbody Fusion Patients in an Ambulatory Surgery Center vs. Hospital Setting

“…In a similar study of the ACS-NSQIP, Garcia et al reviewed single-level TLIF surgery from 2011 to 2013 with the intent of evaluating 30-day re-admission risk factors [13]. This study did not stratify by patient discharge status.…”

“…Of the 4992 patients who met inclusion criteria, 275 (5.5%) were re-admitted within 30 days of their index TLIF procedure and 179 (3.6%) required re-operation of their index TLIF procedure. Following the work by Garcia et al [13], Katz et al reported their review of the ACS-NSQIP database comparing anterior to posterior fusion approaches and the implications to 30-day outcomes [14]. PLIF and TLIF patients were grouped together into posterior fusion and ALIF with LLIF patients were grouped into anterior fusion.…”

“…Over the past several years, a gradual shift has been made toward lumbar fusion approaches that are less invasive and theoretically protective of the thecal sac and nerve roots. Several authors have reported on their experiences of operative and perioperative (30-day) safety via a transforaminal lumbar interbody fusion (TLIF) approach [1][2][3][4][5][6], and more recently, studies examining the safety of outpatient lumbar fusion are on the rise [7][8][9][10][11][12][13][14][15][16]. Depending on the study, complications can be significantly under-reported.…”

Early Discharged Lumbar Spine Fusion Reduced Postoperative Readmissions: A Retrospective Cohort Study

“…The current study aims to investigate differences between patients who were discharged early and those who were not following lumbar fusion surgery, focusing on the rates of readmission and complications that required secondary surgery. Since the rates of success and patient satisfaction for common lumbar fusion surgery have become high in the past decades [16,17], the need for readmission or reoperation was low in each surgeon's or institute's series [18][19][20][21][22]. Therefore, there was rarely an adequate number of patients with high enough rates of follow-up for investigation of readmissions or reoperations in lumbar spinal fusion surgery.…”