Journal article
Causes and risk factors for 30-day unplanned readmissions after lumbar spine surgery
Spine (Philadelphia, Pa. 1976), Vol.39(9), pp.761-768
04/20/2014
DOI: 10.1097/BRS.0000000000000270
PMID: 24525993
Abstract
Retrospective review of a prospective cohort.
To determine the incidence, causes, and risk factors for 30-day unplanned readmissions after lumbar spine surgery.
The rising costs associated with lumbar spinal surgery have received national attention. Recently, the government has chosen to target 30-day readmissions as a quality measure. Few studies have specifically analyzed the incidence, causes, and risk factors for readmission in a multicenter patient cohort.
A large, multicenter clinical registry was queried for all patients undergoing lumbar spine surgery in 2012. Current Procedural Terminology codes were used to select patients undergoing lumbar discectomy, laminectomy, anterior and posterior fusions, and multilevel deformity surgery. Thirty-day readmissions rates and causes were identified and analyzed. Univariate and multivariate logistic regression analyses were used to identify patient characteristics, comorbidities, and operative variables predictive of readmission.
Overall, 695 of 15,668 patients undergoing lumbar spine surgery had unplanned 30-day hospital readmissions (4.4%). When separated by procedure type, readmissions were lowest after discectomy, 3.3%, and highest after deformity surgery, 9.0% (P < 0.001). The top causes for readmission were wound-related (38.6%), pain-related (22.4%), thromboembolic (9.4%), and systemic infections (8.0%). Predictors of readmission included advanced patient age more than 80 years (P = 0.03), African American race (P = 0.03), recent weight loss (P = 0.04), chronic obstructive pulmonary disorder (P < 0.01), history of cancer (P = 0.04), creatinine more than 1.2 (P < 0.01), elevated ASA class (P = 0.01), operative time more than 4 hours (P = 0.01), and prolonged hospital length of stay more than 4 days (P < 0.01).
Thirty-day unplanned readmission rates increased with procedure invasiveness. Both medical and surgical reasons contributed to readmission, many unavoidable. Surgeons should explore optimization measures for those at risk of early, unplanned readmission.
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Details
- Title: Subtitle
- Causes and risk factors for 30-day unplanned readmissions after lumbar spine surgery
- Creators
- Andrew J Pugely - From the Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IAChristopher T MartinYubo GaoSergio Mendoza-Lattes
- Resource Type
- Journal article
- Publication Details
- Spine (Philadelphia, Pa. 1976), Vol.39(9), pp.761-768
- DOI
- 10.1097/BRS.0000000000000270
- PMID
- 24525993
- NLM abbreviation
- Spine (Phila Pa 1976)
- ISSN
- 0362-2436
- eISSN
- 1528-1159
- Publisher
- Lippincott Williams & Wilkins; United States
- Language
- English
- Date published
- 04/20/2014
- Academic Unit
- Orthopedics and Rehabilitation; Internal Medicine
- Record Identifier
- 9984040447502771
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