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

Results

Patient Demographics, Hospital Characteristics, and Comorbidities

There was a total of 4423 patients included in the study with 1657 (37.5%) who encountered either a 30- or 90-day unplanned readmission (30-R: n = 1068 vs. 90-R: n = 589 vs. non-R: n = 2766) (Table 1). The average age of patients with no readmissions trended to be slightly higher than those with 30-day readmissions (30-R: 60.1 ± 15.1 years vs. 90-R: 59.7 ± 13.3 years vs. non-R: 62.1 ± 13.6) (Table 1). A high percentage of patients in the 90-day and no readmission cohorts trended to be from the 0 to 25th percentile of income (30-R: 25.2% vs. 90-R: 30.6% vs. non-R: 26.3%) (Table 1). A high percentage of people whose primary medical payer was Medicare trended to be in the 30-day and no readmission groups (30-R: 44.2% vs. 90-R: 41.7% vs. non-R: 48.1%), whereas private insurers were mostly in the 90-day readmission cohort (30-R: 36.8% vs. 90-R: 41.9% vs. Non-R: 34.5%) (Table 1).

The most common patient comorbidities were HTN (30-R: 57.4% vs. 90-R: 51.4% vs. non-R: 49.9%), smoking (30-R: 33.4% vs. 90-R: 29.0% vs. non-R: 29.8%), deficiency anemia (30-R: 25.6% vs. 90-R: 24.7% vs. non-R: 21.2%), chronic pulmonary disease (30-R: 18.6% vs. 90-R: 15.8% vs. non-R: 16.2%), and diabetes (30-R: 15.1% vs. 90-R: 21.2% vs. non-R: 15.3%) (Table 1).

Perioperative Variables, Complication Rates, and Inpatient Outcomes for Index Admissions

The most commonly performed procedure among all three cohorts was spinal fusion only (30-R: 57.2% vs. 90-R: 57.6% vs. non-R: 53.7%), followed by both (decompression and fusion) and then decompression only (Table 2). The rate of any complication was greatest in the 30-day readmission cohort (30-R: 34.9% vs. 90-R: 32.8% vs. non-R: 33.1%) (Table 2). The most common inpatient complications were postoperative infection (30-R: 16.3% vs. 90-R: 14.3% vs. non-R: 11.5%), acute post-hemorrhagic anemia (30-R: 13.4% vs. 90-R: 14.2% vs. non-R: 14.5%), and genitourinary complication (30-R: 5.7% vs. 90-R: 2.9% vs. non-R: 6.2%) (Table 2).

Both average length of stay (30-R: 12.4 ± 10.7 days vs. 90-R: 9.5 ± 8.9 days vs. non-R: 10.9 ± 11.0 days) and total cost (30-R: $44,172 ± $36,696 vs. 90-R: $37,365 ± $33,449 vs. non-R: $41,609 ± $36,109) for index admissions trended to be higher in the 30-day readmission cohort compared to the 90-day and no readmission cohorts (Table 2). The no-readmission cohort had the highest percentage of routine discharges (30-R: 32.3% vs. 90-R: 36.7% vs. non-R: 41.1%), whereas the 30-day readmission cohort had significantly more discharges to skilled nursing, intermediate, or other facilities (30-R: 35.7% vs. 90-R: 35.1% vs. non-R: 31.5%) as well as to home health care (30-R: 29.4% vs. 90-R: 27.1% vs. non-R: 24.5%) (Table 2).

Thirty- and 90-day Complication Rates

The most prevalent 30- and 90-day complications seen among the readmitted cohorts were sepsis (30-R: 10.2% vs. 90-R: 10.8%), postoperative infection (30-R: 13.7% vs. 90-R: 6.5%), and genitourinary complication (30-R: 3.9% vs. 90-R: 4.1%), followed by acute pain (30-R: 3.9% vs. 2.7%) and pathologic fracture (30-R: 2.4% vs. 90-R: 2.2%) (Table 3). Wound dehiscence, dehydration, hematoma, device complication, acute respiratory failure, and atrial fibrillation were all less common (Table 3).

Multivariate Logistic Regression Predicting 30- and 90-day Unplanned Hospital Readmission

On multivariate regression analysis, HTN (odds ratio [OR]: 1.45, 95% confidence interval [CI]: 1.15–1.82, P = 0.002) and renal failure (OR: 1.53, 95% CI: 1.06–2.23, P = 0.025] during index admission were independently associated with increased 30-day unplanned hospital readmission, whereas age (OR: 0.99, 95% CI: 0.98–0.99, P = 0.005) was independently associated with decreased 30-day unplanned hospital readmission (Table 4). Spinal fusion (OR: 1.41, 95% CI: 1.06–1.88, P = 0.020) and combined fusion and decompression (OR: 1.43, 95% CI: 1.03–1.98, P = 0.032) were less likely to have a 30-day readmission compared to spinal decompression alone, Table 4.

On multivariate analysis, rheumatoid arthritis/collagen vascular disease (OR: 4.08, 95% CI: 1.45–11.51, P = 0.008) was associated with increased 90-day unplanned readmission while coagulopathy (OR: 0.50, 95% CI: 0.26–0.97, P = 0.040) was associated with decreased 90-day unplanned readmission (Table 5).

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