Thirty- and 90-day Readmissions After Spinal Surgery for Spine Metastases

A National Trend Analysis of 4423 Patients

Aladine A. Elsamadicy, MD; Andrew B. Koo, MD; Wyatt B. David, MS; Cheryl K. Zogg, MSPH, MHS; Adam J. Kundishora, MD; Christopher S. Hong, MD; Gregory A. Kuzmik, MD; Ramana Gorrepati, MD; Pedro O. Coutinho, MD; Luis Kolb, MD; Maxwell Laurans, MD, MBA; Khalid Abbed, MD

Disclosures

Spine. 2021;46(12):828-835. 

In This Article

Abstract and Introduction

Abstract

Study Design: Retrospective cohort study.

Objective: The aim of this study was to investigate differences in 30- and 90-day readmissions for spine metastases treated with decompression and/or fusion spine surgery in a nationwide readmission database.

Summary of Background Data: Patients with metastases to the spine represent a particularly vulnerable patient group that may encounter frequent readmissions. However, the 30- and 90-day rates for readmission following surgery for spine metastases have not been well described.

Methods: The Nationwide Readmission Database years 2013 to 2015 was queried. Patients were grouped by no readmission (non-R), readmission within 30 days (30-R), and readmission within 31 to 90 days (90-R). Weighted multivariate analysis assessed impact of treatment approach and clinical factors associated with 30- and 90-day readmissions.

Results: There were a total of 4423 patients with a diagnosis of spine metastases identified who underwent spine surgery, of which 1657 (37.5%) encountered either a 30-or 90-day unplanned readmission (30-R: n = 1068 [24–.1%]; 90-R: n = 589 [13.3%]; non-R: n = 2766). The most prevalent inpatient complications observed were postoperative infection (30-R: 16.3%, 90-R: 14.3%, non-R: 11.5%), acute post-hemorrhagic anemia (30-R: 13.4%, 90-R: 14.2%, non-R: 14.5%), and genitourinary complication (30-R: 5.7%, 90-R: 2.9%, non-R: 6.2%). The most prevalent 30-day and 90-day reasons for admission were sepsis (30-R: 10.2%, 90-R: 10.8%), postoperative infection (30-R: 13.7%, 90-R: 6.5%), and genitourinary complication (30-R: 3.9%, 90-R: 4.1%). On multivariate regression analysis, surgery type, age, hypertension, and renal failure were independently associated with 30-day readmission; rheumatoid arthritis/collagen vascular diseases, and coagulopathy were independently associated with 90-day readmission.

Conclusion: In this study, we demonstrate several patient-level factors independently associated with unplanned hospital readmissions after surgical treatment intervention for spine metastases. Furthermore, we find that the most common reasons for readmission are sepsis, postoperative infection, and genitourinary complications.

Level of Evidence: 3

Introduction

National health care costs have soared in recent years, with readmissions playing a major role.[1] Unplanned readmissions cost the US health care system upwards of $20 billion annually, with approximately one in every seven Medicare beneficiaries experiencing readmission within 30 days of a major surgical procedure.[2,3]Furthermore, hospitals with high readmissions rates were found to have higher rates of surgical mortality as well.[3] Thus, decreasing unplanned readmissions has become a major target of healthcare reform, both to decrease costs and increase quality of care.[4,5] This was made into policy via the Affordable Care Act, whereby the Centers for Medicare and Medicaid penalized hospitals with exceptionally high rates of readmission and rewarded those with low readmission rates.[6] Therefore, it is necessary to identify factors driving readmissions so as to decrease health care expenditures and improve patient care.

The main surgical treatments used for spine metastases are spinal decompression with or without fusion, with the goal of alleviating pain and restoring function, or to provide tumor separation from the spinal cord for radiation.[7,8] However, surgical resection of spinal metastases may be complicated due to numerous patient comorbidities and the technical difficulty of the procedure, predisposing patients to increased rates postoperative complications and unplanned readmissions.[9] Rates of complication following surgical intervention for spinal metastasis have been shown to be anywhere between 20.0% and 34.3%, with high rates of pulmonary complications and postoperative hemorrhages.[10–12] There have been a few studies attempting to quantify rates of readmission following surgical intervention for spine metastases, reportedly as high as 17% at the 30-day mark and 11.9% at the 90-day mark.[13,14] However, there remains a paucity of data identifying rates and driving factors for 30- and 90-day unplanned hospital readmission on a national level.

We used patient data from the National Readmission Database (NRD) in this large retrospective study to identify overall readmission rates as well as factors driving these readmissions following decompression with or without fusion for spine metastases.

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