gms | German Medical Science

Objectives: Readmission is becoming an important metric for quality and efficiency of healthcare. Readmission and its predictors following spine surgery are overall poorly understood and very limited evidence is available specifically in lumbar spinal fusion surgery. Administrative databases can help provide highly significant as well as mostly unbiased data, which can be utilized to analyze, evaluate and potentially improve risk stratification and optimize patient outcome. The objective of the present study was to analyze the current extent of 90-day readmission to hospital or emergency room and evaluate risk factors associated with readmission after lumbar spinal fusion surgery using a New York administrative database.

Methods: The New York Statewide Planning and Research Cooperative System (SPARCS) was utilized to capture patients undergoing primary lumbar spinal fusion surgery for degenerative pathologies of the lumbar spine from 2005-2014. All diagnosis and procedures were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Socio-demographic characteristics included age, race, gender, and insurance status. Clinical characteristics included medical type of procedure, medical comorbidities and fusion length. Temporal trend of 90-day readmission was assessed using Cochrane-Armitage test. Logistics regression was used to examine predictors associated with 90-day readmission.

Results and Conclusion: There were 86,869 patients included in his large cohort study. The overall 90-day readmission rate was 24.8%. The leading 90-day complications were neurological complications (3.8%), wound complications (3.7%), wound infections (3.1%) and pulmonary embolism (2.7%). On a multivariable analysis model, age (OR comparing ≥75 versus <35 years: 1.23 , 95% CI: 1.13-1.35)), sex (OR female to male: 1.19 (1.15-1.23)), race (OR African American to white: 1.60 (1.52-1.70)), insurance (OR Medicaid to Medicare: 1.45 (1.35-1.56)), procedures (OR: comparing thoracolumbar fusion to posterior / transforaminal lumbar interbody fusion (81.04 to 81.08; 2.11(1.49-2.97)), number of operated spinal levels (OR comparing 4-8 vertebrae to 2-3 vertebrae: 2.39 (2.06-2.77)), coronary artery disease (OR: 1.26 (1.19-1.33)), chronic pulmonary disease (OR: 1.28 (1.23-1.34)), congestive heart failure (OR:1.52 (1.34-1.72)), and diabetes (OR:1.30 (1.25-1.36) were significantly associated with 90-day readmission.

Age, sex, race, insurance, procedures, number of operated levels and comorbidities are major risk factors for 90-day readmission. Our study allows risk calculation using claims data to determine high risk patients before undergoing spinal fusion surgery in order to prevent early readmission, improve quality of care and reduce health care expenditures.