Factors Associated With Cost of 30-Day and 90-Day Readmissions Following Anterior Cervical Discectomy and Fusion: Insights From the Nationwide Readmissions Database. (1st September 2019)

• Record Type: Journal Article
• Authors: Goyal, Anshit; Bhandarkar, Archis; Alvi, Mohammed A; Bydon, Mohamad
• Is Part Of: Neurosurgery. Volume 66(2010)Supplement 1
• Publication Date: 2019-09-01
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyz310_328
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: The rising cost of spine surgery and the resultant economic burden has attracted the attention of health policy makers. Readmissions constitute a significant economic burden to the healthcare system. METHODS: We queried the Healthcare Cost and Utilization Project (HCUP) Nationwide Readmissions Database (NRD) for patients undergoing elective ACDF during 2012 to 2015Q3. Multivariable linear regression was performed to establish the factors associated with cost of each 30/90-d readmission episode (REC). We also determined the procedure-related and medical diagnosis at readmission associated with higher cost of hospitalization. RESULTS: A total of 4792 30-d readmissions from 4512 patients and 8156 90-d readmissions from 7198 patients were included. The average 30-d REC was $11, 843 (95% CI: $11, 390–$12, 297) and the average 90-d REC was $14, 353 (95% CI: $13, 962–$14, 744). Number of procedures at index admission (IA), length of stay at IA, and days since IA that the readmission occurred were the top predictors of readmission cost. Other important predictors ( P < .001) included a diagnosis of cervical spondylosis with myelopathy at IA and weekend IAs. Cervical myelopathy and aspiration pneumonia emerged as the procedure and medical-related readmission diagnoses associated with the highest 30-d readmission costs respectively. Device-related mechanical complications and symptom recurrence were the diagnoses associated with the highest cost of 90-d RECs respectively. CONCLUSION: In this analysis from a national database, we determined the factors associated with cost of readmissions following elective ACDF. Our results indicate that a significant economic burden of readmissions is due to medical diagnoses, apart from procedure related complications.