Weekend Admission Increases Risk of Readmissions Following Elective Thoracolumbar Spinal Fusion

Rosenberg, Ashley; Dominy, Calista; Bueno, Brian; Pasik, Sara; Yeshoua, Brandon; Cho, Brian; Arvind, Varun; Valliani, Aly; Markowitz, Jonathan; Kim, Jun

doi:10.1177/21925682221120788

Cited by 6 publications

(10 citation statements)

References 30 publications

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“…We also explored differences associated patient readmissions to hospital as a secondary process outcome. Unlike Rosenberg et al 36 who found that 30‐day readmissions were significantly greater for patients undergoing a specific elective surgery procedure admitted at the weekend, we observed no clear after‐hours effect for our 30‐day readmission models. However, there were a number of significant case‐mix interactions, and socioeconomic disadvantage and DRG complexity are persistent interactions in the “Extended” and “Twilight” models.…”

Section: Discussioncontrasting

confidence: 99%

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Mortality and readmission differences associated with after‐hours hospital admission: A population‐based cohort study in Queensland Australia

Bell

Boyle

Rolls

et al. 2023

Health Science Reports

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Background and Aims Policy makers and health system managers are seeking evidence on the risks involved for patients associated with after‐hours care. This study of approximately 1 million patients who were admitted to the 25 largest public hospitals in Queensland Australia sought to quantify mortality and readmission differences associated with after‐hours hospital admission. Methods Logistic regression was used to assess whether there were any differences in mortality and readmissions based on the time inpatients were admitted to hospital (after‐hours versus within hours). Patient and staffing data, including the variation in physician and nursing staff numbers and seniority were included as explicit predictors within patient outcome models. Results After adjusting for case‐mix confounding, statistically significant higher mortality was observed for patients admitted on weekends via the hospital's emergency department compared to within hours. This finding of elevated mortality risk after‐hours held true in sensitivity analyses which explored broader definitions of after‐hours care: an “Extended” definition comprising a weekend extending into Friday night and early Monday morning; and a “Twilight” definition comprising weekends and weeknights. There were no significant differences in 30‐day readmissions for emergency or elective patients admitted after‐hours. Increased mortality risks for elective patients was found to be an evening/weekend effect rather than a day‐of‐week effect. Workforce metrics that played a role in observed outcome differences within hours/after‐hours were more a time of day rather than day of week effect, i.e. staffing impacts differ more between day and night than the weekday versus weekend. Conclusion Patients admitted after‐hours have significantly higher mortality than patients admitted within hours. This study confirms an association between mortality differences and the time patients were admitted to hospital, and identifies characteristics of patients and staffing that affect those outcomes.

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Section: Discussioncontrasting

confidence: 99%

“…We also explored differences associated patient readmissions to hospital as a secondary process outcome. Unlike Rosenberg et al 36 F I G U R E…”

Section: Notementioning

confidence: 86%

Mortality and readmission differences associated with after‐hours hospital admission: A population‐based cohort study in Queensland Australia

Bell

Boyle

Rolls

et al. 2023

Health Science Reports

View full text Add to dashboard Cite

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“…6,7 Studies have found weekend admission to be associated with higher risk of mortality, cost, increased length of stay (LOS), and worse outcomes in patients undergoing spine procedures for idiopathic scoliosis, 8 cervical fusion due to trauma, 9 and thoracolumbar fusion. 10 However, other studies have found no association between index weekend admission and complication or mortality rates in emergent spinal cord injury patients. 11 Although risk factors for readmission in patients undergoing cervical spinal fusions have been identified, 12 the day of surgery was not considered.…”

Section: Neurospine Eissn 2586-6591 Pissn 2586-6583mentioning

confidence: 97%

“…To our knowledge, weekend admission has only been described as a risk factor for 30-day readmission in the context of posterior cervical spine surgery and thoracolumbar spine fusion. 10,12 A study using 2014 NRD data for ACDF subjects suggest payor status, NRD, comorbidities, and LOS are significant predictors for readmission, but weekend admission was not found to be a risk factor for readmission rates. 25 Other studies identify payor status and race, 26 and all-cause complications, Medicaid insurance, hospital bed size, and age, 27 as predictors for high readmission rates.…”

Section: Readmission Ratesmentioning

confidence: 99%

“…23,26 Though Neifert et al 28 found NHD and postdischarge complications to be independent predictors of readmission, they did not observe the reason for readmission in these cases. Rosenberg et al 10 identified DVT, infections, and nonroutine discharge to be risk factors for 30-day readmission in patients with index weekend admission for thoracolumbar fusion surgery. In our ECSF cohort, the most common diagnoses upon readmission are related to postprocedural pain, infections, and surgical site complications.…”

Section: Readmission Ratesmentioning

confidence: 99%

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Weekend Admission Increases Risk of Readmissions Following Elective Cervical Spinal Fusion

et al. 2023

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Objective: The “weekend effect” occurs when patients cared for during weekends versus weekdays experience worse outcomes. But reasons for this effect are unclear, especially amongst patients undergoing elective cervical spinal fusion (ECSF). Our aim was to analyze whether index weekend admission affects 30- and 90-day readmission rates post-ECSF.Methods: All ECSF patients > 18 years were retrospectively identified from the 2016–2018 Healthcare Cost and Utilization Project Nationwide Readmissions Database (NRD), using unique patient linkage codes and International Classification of Diseases, Tenth Revision codes. Patient demographics, comorbidities, and outcomes were analyzed. Univariate logistic regression analyzed primary outcomes of 30- and 90-day readmission rates in weekday or weekend groups. Multivariate regression determined the impact of complications on readmission rates.Results: Compared to the weekday group (n = 125,590), the weekend group (n = 1,026) held a higher percentage of Medicare/Medicaid insurance, incurred higher costs, had longer length of stay, and fewer routine home discharge (all p < 0.001). There was no difference in comorbidity burden between weekend versus weekday admissions, as measured by the Elixhauser Comorbidity Index (p = 0.527). Weekend admissions had higher 30-day (4.30% vs. 7.60%, p < 0.001) and 90-day (7.80% vs. 16.10%, p < 0.001) readmission rates, even after adjusting for sex, age, insurance status, and comorbidities. All-cause complication rates were higher for weekend admissions (8.62% vs. 12.7%, p < 0.001), specifically deep vein thrombosis, infection, neurological conditions, and pulmonary embolism.Conclusion: Index weekend admission increases 30- and 90-day readmission rates after ECSF. In patients undergoing ECSF on weekends, postoperative care for patients at risk for specific complications will allow for improved outcomes and health care utilization.

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Impact of Weekday on Short-term Surgical Outcomes After Lumbar Fusion Surgery

Heard,

Ezeonu,

Lee

et al. 2024

Clinical Spine Surgery

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Study Design: Retrospective cohort study. Objective: The purpose of this study is to investigate whether weekday lumbar spine fusion surgery has an impact on surgical and inpatient physical therapy (PT) outcomes. Summary of Background Data: Timing of surgery has been implicated as a factor that may impact outcomes after spine surgery. Previous literature suggests that there may be an adverse effect to having surgery on the weekend. Methods: All patients ≥18 years who underwent primary lumbar spinal fusion from 2014 to 2020 were retrospectively identified. Patients were subdivided into an early subgroup (surgery between Monday and Wednesday) and a late subgroup (surgery between Thursday and Friday). Surgical outcome variables included inpatient complications, 90-day readmissions, and 1-year revisions. PT data from the first inpatient PT session included hours to PT session, AM-PAC Daily Activity or Basic Mobility scores, and total gait trial distance achieved. Results: Of the 1239 patients identified, 839 had surgery between Monday and Wednesday and 400 had surgery between Thursday and Friday. Patients in the later surgery subgroup were more likely to experience a nonsurgical neurologic complication (3.08% vs. 0.86%, P=0.008); however, there was no difference in total complications. Patients in the early surgery subgroup had their first inpatient PT session earlier than patients in the late subgroup (15.7 vs. 18.9 h, P<0.001). However, patients in the late subgroup achieved a farther total gait distance (98.2 vs. 75.4, P=0.011). Late surgery was a significant predictor of more hours of PT (est.=0.256, P=0.016) and longer length of stay (est.=2.277, P=0.001). There were no significant differences in readmission and revision rates. Conclusions: Patients who undergo surgery later in the week may experience more nonsurgical neurologic complications, longer wait times for inpatient PT appointments, and longer lengths of stay. This analysis showed no adverse effect of later weekday surgery as it relates to total complications, readmissions, and reoperations. Level of Evidence: Level III.

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Weekend Admission Increases Risk of Readmissions Following Elective Thoracolumbar Spinal Fusion

Cited by 6 publications

References 30 publications

Mortality and readmission differences associated with after‐hours hospital admission: A population‐based cohort study in Queensland Australia

Mortality and readmission differences associated with after‐hours hospital admission: A population‐based cohort study in Queensland Australia

Weekend Admission Increases Risk of Readmissions Following Elective Cervical Spinal Fusion

Impact of Weekday on Short-term Surgical Outcomes After Lumbar Fusion Surgery

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