Predictors of 30-Day Hospital Readmission After Posterior Cervical Fusion in 3401 Patients. Issue 5 (1st March 2018)

• Record Type: Journal Article
• Authors: Choy, Winward; Lam, Sandi K.; Smith, Zachary A.; Dahdaleh, Nader S.
• Is Part Of: Spine. Volume 43:Issue 5(2018)
• Publication Date: 2018-03-01
• Subjects: anemia -- cervical -- complication -- fusion -- National Surgical Quality Improvement Program -- posterior -- posterior cervical fusion -- readmission -- spine -- surgery; Spine -- Abnormalities -- Periodicals; Spine -- Diseases -- Periodicals; Spine -- Surgery -- Periodicals; 616.73005
• DOI: 10.1097/BRS.0000000000001450
• Languages: English
• ISSNs: 0362-2436

Abstract

Abstract : Study Design: Retrospective cohort study. Objective: The aim of the study was to determine readmission rates and predictors of readmission after posterior cervical fusion (PCF). Summary of Background Data: PCFs are common spinal operations for a variety of spinal disorders including cervical myelopathy, unstable fractures, cervical deformity, and tumors. Data elaborating on risk factors for 30-day readmission are limited. Methods: Data were collected from the 2006 to 2013 American College of Surgeons National Surgical Quality Improvement Program database. Predictors of 30-day readmission comprising patient demographics, comorbidities, operative features, and postoperative complications were identified through logistic multivariable regression. Results: A total of 3401 patients met study criteria. Rate of 30-day readmission was 6.20%. Multilevel fusion was performed in 69.16% of patients. Postoperative infection was the most reason, accounting for 17.06% of all readmissions. Age older than 70 years (odds ratio [OR] = 1.61, P = 0.012), renal failure requiring dialysis (OR = 3.69, P = 0.011), anemia (OR = 1.57, P = 0.006), multilevel fusion (OR = 1.61, P = 0.012), surgical site infections (OR = 20.4, P < 0.001), wound dehiscence (OR = 19.08, P < 0.001), postoperative pneumonia (OR = 2.75, P = 0.01), pulmonary embolism (OR = 15.39, P < 0.001), and progressing renal insufficiency (OR = 10.13, P = 0.061) were significant predictors of hospital readmission. Conclusion: The identified predictors of readmission after PCF can improve patient counseling, identification of high-risk patients, and guide changes in healthcare delivery pathways. Patients with modifiable risk factors such as anemia and kidney failure may benefit from preoperative optimization. In addition, postoperative complications represent a key target for intervention. Level of Evidence: 3 Abstract : Supplemental Digital Content is available in the text