Predictors of Thirty-Day Readmission After Anterior Cervical Fusion
- 15 January 2014
- journal article
- cervical spine
- Published by Ovid Technologies (Wolters Kluwer Health) in Spine
- Vol. 39 (2), 127-133
- https://doi.org/10.1097/brs.0000000000000051
Abstract
Study Design. Retrospective cohort study. Objective. To determine the incidence of and factors predicting 30-day readmission after anterior cervical discectomy and fusion (ACDF). Summary of Background Data. ACDF is being performed on an increasing basis on a wider population of patients, which is accompanied by rising costs. Readmissions have the potential to further deplete health care resources. Although past studies have shown that readmissions after surgery are driven by operative complications, specific predictors of readmission after ACDF are not well researched. Methods. All patients who underwent ACDF or anterior corpectomy and fusion procedures in 2011 were selected from the American College of Surgeon's National Quality Improvement database. Readmissions were analyzed on the basis of demographics, comorbidities, operative characteristics, and complications were compared in univariate analyses. Multivariate logistic regression models were created to isolate the independent effects of preoperative and postoperative factors on readmission. Results. The nationwide readmission rate after ACDF surgery in this study is 2.5%. Pulmonary complications (8.5%), wound complications (8.5%), and urinary tract infections (8.5%) are the most common complications seen in readmitted patients. Readmitted patients were significantly older (58 vs. 53, P = 0.003), with higher rates of diabetes and hypertension (28.8% vs. 13.9%, P = 0.001; 64.4% vs. 42.6%, P = 0.001, respectively). Although certain preoperative factors such as age 65 years or more and preoperative stay more than 24 hours increase the odds of operative complications (odds ratio, 3.5; 95% confidence interval, 2.0–6.0 and odds ratio, 6.2; 95% confidence interval, 3.4–11.1, respectively), hypertension may independently increase the likelihood of readmission outside of any effect on complications (odds ratio, 1.8; 95% confidence interval, 1.0–3.4). Conclusion. The data in this study suggests that surgeons are already controlling readmission rates by limiting peri- and postoperative complications, but patients with a history of hypertension could have an increased likelihood of being readmitted despite avoiding a complication. Level of Evidence: 3Keywords
This publication has 16 references indexed in Scilit:
- Patient factors, comorbidities, and surgical characteristics that increase mortality and complication risk after spinal arthrodesis: a prognostic study based on 5,887 patientsThe Spine Journal, 2013
- Preoperative Anemia and Perioperative Outcomes in Patients Who Undergo Elective Spine SurgerySpine, 2013
- Effect of Smoking on the Perioperative Outcomes of Patients Who Undergo Elective Spine SurgerySpine, 2013
- Outpatient Surgery Reduces Short-Term Complications in Lumbar DiscectomySpine, 2013
- Validation of New Readmission Data in the American College of Surgeons National Surgical Quality Improvement ProgramJournal of the American College of Surgeons, 2013
- Thirty-day readmissions after elective spine surgery for degenerative conditions among US Medicare beneficiariesThe Spine Journal, 2012
- Toward Robust Information: Data Quality and Inter-Rater Reliability in the American College of Surgeons National Surgical Quality Improvement ProgramJournal of the American College of Surgeons, 2010
- The Patient Safety in Surgery Study: Background, Study Design, and Patient PopulationsJournal of the American College of Surgeons, 2007
- A simulation study of the number of events per variable in logistic regression analysisJournal of Clinical Epidemiology, 1996
- Hospital Readmissions in the Medicare PopulationThe New England Journal of Medicine, 1984