Independent Patient Risk Factors Associated With Increased Length of Hospital Stay, Unplanned Return to Operating Room, and 30-Day Readmission Rates After Posterior Cervical Fusion for Cervical Spondylotic Myelopathy. (1st September 2019)

• Record Type: Journal Article
• Authors: Elsamadicy, Aladine A; Chouairi, Fouad; Lee, Megan; Koo, Andrew B; Kundishora, Adam; Camara-Quintana, Joaquin Q; Kolb, Luis; Laurans, Maxwell S H; Abbed, Khalid M
• 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_815
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: The aim of this study was to determine risk factors associated with readmissions, reoperation, and extended length of stay (LOS) following posterior cervical fusion (PCF) for spondylotic myelopathy. METHODS: The National Surgical Quality Improvement Program from 2011 to 2016 was queried for all patients undergoing PCF with a diagnosis of spondylotic myelopathy. The inclusion criteria for this project were defined by the CPT code 22600 for PCF. Patients with a history of trauma, malignancy, and those with nonelective surgery were excluded. Patients without ICD9 (721.1) or ICD10 (M47.12) codes for myelopathy were also excluded. For analysis, patients were classified into 2 cohorts: patients who were readmitted, and those who were not readmitted. Patient demographics, comorbidities, intraoperative variables, and number of levels involved in surgery were collected. RESULTS: A total of 893 patients with PCF for spondylotic myelopathy were identified, of which 816 (91.4%) were not readmitted and 77 (8.6%) were readmitted.The readmitted cohort was significantly older (No Readmission: 62.6 +/–10.8 vs Readmission: 65.5 +/– 10.8, P = .029). The readmitted population had a significantly higher proportion of dyspnea on exertion (No Readmission: 8.1% vs Readmission: 15.6%, P = .026) and COPD (No Readmission: 6.9% vs Readmission: 14.3%, P = .018). There were no differences in operative time ( P = .762) or multilevel surgeries ( P = .453) between the 2 cohorts. LOS was similar between readmitted and nonreadmitted patients ( P = .640). Upon logistic regression controlling for demographics, comorbidities, surgery level, and operative time, multiple risk factors predicted extended LOS, including female gender, black race, noninsulin-dependent diabetes, chronic steroid use, and length of surgery. BMI and CHF predicted an unplanned return to the operating room. Age [OR: 1.03, 95% CI (1.004-1.06), P = .025] was the single predictor of readmission. CONCLUSION: Our study suggests that while there are a host of risk factors for both reoperation and extended LOS, increased age is likely the most significant risk factor for readmission following PCF.