Risk Factors for 30-Day and 90-Day Readmission After Lumbar Decompression

Jose A. Canseco, MD, PhD; Brian A. Karamian, MD; Paul D. Minetos, MD, MBA; Taylor M. Paziuk, MD; Alyssa Gabay, BA; Ariana A. Reyes, MD; Joseph Bechay, BS; Kevin B. Xiao, MS; Blake O. Nourie, BS; I. David Kaye, MD; Barrett I. Woods, MD; Jeffrey A. Rihn, MD; Mark F. Kurd, MD; D. Greg Anderson, MD; Alan S. Hilibrand, MD; Christopher K. Kepler, MD, MBA; Gregory D. Schroeder, MD; Alexander R. Vaccaro, MD, PhD, MBA

Disclosures

Spine. 2022;47(9):672-679. 

In This Article

Abstract and Introduction

Abstract

Study Design: Retrospective cohort study.

Objective: To assess readmission rates and risk factors for 30-day and 90-day readmission after elective lumbar decompression at a single institution.

Summary of Background Data: Hospital readmission is an undesirable aspect of interventional treatment. Studies evaluating readmissions after elective lumbar decompression typically analyze national databases, and therefore have several drawbacks inherent to their macroscopic nature that limit their clinical utility.

Methods: Patients undergoing primary one- to four-level lumbar decompression surgery were retrospectively identified. Demographic, surgical, and readmission data within "30-days" (0–30 days) and "90-days" (31–90 days) postoperatively were extracted from electronic medical records. Patients were categorized into four groups: (1) no readmission, (2) readmission during the 30-day or 90-day postoperative period, (3) complication related to surgery, and (4) Emergency Department (ED)/Observational (OBs)/Urgent (UC) care.

Results: A total of 2635 patients were included. Seventy-six (2.9%) were readmitted at some point within the 30- (2.3%) or 90-day (0.3%) postoperative periods. Patients in the pooled readmitted group were older (63.1 yr, P < 0.001), had a higher American Society of Anesthesiologists (ASA) grade (31.2% with ASA of 3, P = 0.03), and more often had liver disease (8.1%, P = 0.004) or rheumatoid arthritis (12.0%, P = 0.02) than other cohorts. A greater proportion of 90-day readmissions and complications had surgical-related diagnoses or a diagnosis of recurrent disc herniation than 30-day readmissions and complications (66.7% vs. 44.5%, P = 0.04 and 33.3% vs. 5.5%, P < 0.001, respectively). Age (Odds ratio [OR]: 1.02, P = 0.01), current smoking status (OR: 2.38, P < 0.001), longer length of stay (OR: 1.14, P < 0.001), and a history of renal failure (OR: 2.59, P = 0.03) were independently associated with readmission or complication.

Conclusion: Increased age, current smoking status, hospital length of stay, and a history of renal failure were found to be significant independent predictors of inpatient readmission or complication after lumbar decompression.

Introduction

Lumbar spinal stenosis (LSS) is a common pathology seen in adults over 50 years of age.[1,2] A degenerative disease, LSS is associated not only with narrowing of the central spinal canal, but also the lateral recesses and neural foramina.[3–5] This narrowing can be attributed to several different pathologies including intervertebral disc herniation, spondylosis, hypertrophic ligamentum, and spondylolisthesis.[3] The symptoms attributed to LSS are generally dependent on the location of the neural compression, with neurogenic claudication and radiculopathy resulting from central canal and lateral recess/foraminal stenosis, respectively.[6] As the incidence of symptomatic LSS continues to rise with an increasingly elderly population, so too are the costs associated with treating these patients.[7–9]

Treatment strategies for symptomatic LSS are similar to many degenerative spinal conditions, beginning with nonoperative therapy in the form of systemic or local antiinflammatory medications and targeted physical therapy.[3,10–15] In cases that are refractory to nonoperative management or are associated with a progressive neurologic deficit, surgical decompression is indicated to prevent the significant morbidity associated with LSS induced immobility.[16,17] While there are several different techniques for achieving neural decompression, laminectomy with or without fusion remains a well- established and evidence-based technique for addressing LSS.[18–27] The Maine Lumbar Spine Study prospectively assessed clinical outcomes in patients undergoing treatment for LSS and found that operative intervention was superior to nonsurgical management with regard to relieving radicular symptoms and improving functional status at short- and longterm follow-up.[19,20,28] Similarly, the Spine Research Outcomes Research Trial (SPORT) also found improved short- and long-term clinical outcomes for patient undergoing operative versus nonoperative intervention for symptomatic LSS in their prospective evaluation.[22,25] While the literature demonstrates that neural decompression results in improved clinical outcomes for patients with refractory LSS, some patients' recoveries are complicated by hospital readmissions in the acute postoperative period.

Hospital readmission following any surgical procedure is an undesirable aspect of interventional treatment. Aside from the potential adverse patient clinical outcomes, postoperative readmissions are also associated with significant clinical and financial ramifications, especially in an era of bundle payment-based reimbursement. Studies evaluating these events that utilize national databases, such as National Surgical Quality Improvement (NSQIP), allow for a largescale assemblage of data but have several drawbacks inherent to their macroscopic nature, limiting their clinical utility. By reporting only 30-day readmissions after surgery, patients readmitted outside of the observational period, even if the readmission is related to the index procedure, are not tracked.[29] Additionally, by only accounting for readmission at the location of the index procedure, true readmission rates are likely underrepresented.[29] Therefore, the primary aim of this study is to more accurately assess readmission rates and specific risk factors for both 30-day and 90-day patient readmission after isolated elective lumbar decompression at a single institution.

processing....