Unplanned Readmissions after Spine Surgery: A Single-Center Prospective Analysis of a 90-Day Model in 2,860 Cases

Abstract

During the last decades, an emergence of unplanned readmissions has been shown to be a useful tool to gage the healthcare quality and hospital performance. Previous studies were limited by their retrospective designs based on database information and short-term 30-day follow-up intervals. We analyzed the incidence and causes for unplanned readmissions following spine surgery at a 90-day interval and the difference at 30-, 31-60-, and 61-90-day intervals after discharge. Additionally, we assessed total beddays lost and the economic impact of readmissions and probable risk factors. Overview of Literature: Recent reports on readmission rates suggested the contribution of this parameter for the assessment of healthcare quality. Methods: A prospective analysis of 2,860 admissions was performed over 1 year in a tertiary care orthopedic hospital. All unscheduled readmissions following spine surgery within 90 days of discharge were included, irrespective of type or location of surgery. Polytrauma, primary osseous infections, and planned readmissions were excluded. Results: Our readmission rate was 3.32% (95/2,860). Leading readmission causes were surgical site infections (SSIs) accounting for 44.21% (n=42; superficial, 23; deep, 11; organ and space, 8), followed by aseptic pain 31.58% (n=30) and medical causes 13.68% (n=13). Though 86.95% of superficial SSIs occurred within 30 days, 21.1% of deep SSIs occurred beyond 30 days. During the 30-90-day interval, 33.68% of readmissions occurred. The financial burden amounted to 41,93,660 Indian Rupees, and the mean bed-days lost was 7.33 per readmission. Hospital stay ≥10 days, health insurance, and comorbid illnesses (diabetes, hypertension, and liver disease) were associated with readmissions (p<0.05). Conclusions: Our study showed that SSIs and aseptic pain were the leading causes of readmissions at 90 days after spine surgery. Limiting the analysis to 30-day readmissions as in previous studies would lead to failure in the identification of more severe complications like deep SSIs. Continued vigilance, particularly for patients with predisposing factors, could help alleviate the financial burden.

Reasons for transfer and subsequent outcomes among patients undergoing elective spine surgery at an orthopedic specialty hospital

“…showed a readmission rate of 3.32%. [ 14 ] In their study, the most common cause of readmission was surgical site infection, accounting for 44.21% of all 90-day readmissions. [ 14 ] McCormack et al .…”

“…[ 14 ] In their study, the most common cause of readmission was surgical site infection, accounting for 44.21% of all 90-day readmissions. [ 14 ] McCormack et al . similarly reported a 30-day readmission rate of 3.8% following spine surgery at a OSH.…”

Predictors of hospital readmission within 30 days after surgery for thoracolumbar fractures: A mixed approach

“…Wound complications, sepsis, pain management, pneumonia, and pulmonary emboli or deep vein thrombosis have been reported as the most common causes of patient readmission after spine surgery 2 . Studies attributed most 30‐day readmissions in spine surgery to non‐surgical complications and recognized the role of coordinated care with the primary care physician upon discharge 2,34–37 …”

Is Routine Use of Drain Really Necessary for Posterior Lumbar Interbody Fusion Surgery? A Retrospective Case Series with a Historical Control Group

“…In the setting of spinal surgery, one of the biggest concerns is the postoperative epidural hematoma. 7 , 32 - 37 Hematoma could be the feasible medium for bacterial colonization, and the space-occupying lesion compressing the neural tissue might subsequently induce abrupt re-aggravation of leg pain, neurological deficit, or more seriously, cauda equina syndrome. 7 , 33 , 35 , 36 In general, a surgical drain has been widely used with the theoretical expectation of preventing these complications.…”