Risk Factors for 30-Day Unplanned Readmission and Major Perioperative Complications After Spine Fusion Surgery in Adults: A Review of the National Surgical Quality Improvement Program Database

Overview

Journal Spine (Phila Pa 1976)

Specialty Orthopedics

Date 2016 Mar 12

PMID 26967124

Citations 22

Authors

Alvin W Su

Elizabeth B Habermann

Kristine M Thomsen

Todd A Milbrandt

Ahmad Nassr

A Noelle Larson

Affiliations

Soon will be listed here.

Abstract

Study Design: Retrospective review of a prospective cohort.

Objective: The aim of the study was to determine the patient characteristics and surgical procedure factors related to increased rates of 30-day unplanned readmission and major perioperative complications after spinal fusion surgery, and the association between unplanned readmission and major complications.

Summary Of Background Data: Reducing unplanned readmissions can reduce the cost of healthcare. Payers are implementing penalties for 30-day readmissions after discharge. There is limited data regarding the current rates and risk factors for unplanned readmission and major complications related to spinal fusion surgery.

Methods: Spine fusion patients were identified using the 2012 and 2013 American College of Surgeons National Surgical Quality Improvement Program Participant User File. Rates of readmissions within 30 days after spine fusion surgery were calculated using the person-years method. Cox proportional hazards models were used to assess the independent associations of spine surgical procedure types, diagnoses, patient profiles, and major perioperative complications with unplanned related readmissions. Independent risk factors for major complications were assessed by multivariable logistic regression.

Results: Of the 18,602 identified patients, there was a 5.2% overall major perioperative complication rate. There was a rate of 4.4% per 30 person-days for unplanned readmissions related to index surgery. Independent risk factors for both readmissions and major perioperative complications included combined anterior and posterior surgery, diagnosis of solitary tumor, older age, and higher American Society of Anesthesiologists class. Patients with deep/organ surgical site infection carried higher risk of having unplanned readmission, followed by pulmonary embolism, acute renal failure, and stroke/cerebral vascular accident with neurological deficit.

Conclusion: This study provides benchmark rates of 30-day readmission based on diagnosis and procedure codes from a high-quality database for adult spinal fusion patients and showed increased rates of 30-day unplanned readmission and major perioperative complications for patients with specific risk factors. Targeted preoperative planning on modifiable risk factors with proportional reimbursement may promote higher-quality healthcare.

Level Of Evidence: 3.

Citing Articles

Use of multidisciplinary positive deviance seminars to improve efficiency in a high-volume arthroplasty practice: a pilot study.

Gold R, Al Zoubi F, Brillinger J, Kreviazuk C, Garvin D, Schramm D Can J Surg. 2023; 66(1):E1-E7.

PMID: 36596585 PMC: 9829057. DOI: 10.1503/cjs.018121.

The application of artificial intelligence in spine surgery.

Zhou S, Zhou F, Sun Y, Chen X, Diao Y, Zhao Y Front Surg. 2022; 9:885599.

PMID: 36034349 PMC: 9403075. DOI: 10.3389/fsurg.2022.885599.

Predicting 30-Day Perioperative Outcomes in Adult Spinal Deformity Patients With Baseline Paralysis or Functional Dependence.

Alas H, Ihejirika R, Kummer N, Passfall L, Krol O, Bortz C Int J Spine Surg. 2022; 16(3):427-434.

PMID: 35728828 PMC: 9650157. DOI: 10.14444/8261.

Association of Preoperative Hemoglobin A1c and Body Mass Index with Wound Infection Rate in Spinal Surgery.

Ross M, Iyer S, Gundle K, Ross D Int J Spine Surg. 2021; 15(4):811-817.

PMID: 34285126 PMC: 8375695. DOI: 10.14444/8104.

Effect of Surgical Setting on Cost and Hospital Reported Outcomes for Single-Level Anterior Cervical Discectomy and Fusion.

Weir T, Usmani M, Camacho J, Sokolow M, Bruckner J, Jazini E Int J Spine Surg. 2021; 15(4):701-709.

PMID: 34266936 PMC: 8375676. DOI: 10.14444/8092.

References

Pugely A, Martin C, Gao Y, Mendoza-Lattes S . Causes and risk factors for 30-day unplanned readmissions after lumbar spine surgery. Spine (Phila Pa 1976). 2014; 39(9):761-8. DOI: 10.1097/BRS.0000000000000270. View

Shubert C, Habermann E, Truty M, Thomsen K, Kendrick M, Nagorney D . Defining perioperative risk after hepatectomy based on diagnosis and extent of resection. J Gastrointest Surg. 2014; 18(11):1917-28. DOI: 10.1007/s11605-014-2634-x. View

Cheng S, Chen C, Chang W . Hospital response to a global budget program under universal health insurance in Taiwan. Health Policy. 2009; 92(2-3):158-64. DOI: 10.1016/j.healthpol.2009.03.008. View

Veeravagu A, Patil C, Lad S, Boakye M . Risk factors for postoperative spinal wound infections after spinal decompression and fusion surgeries. Spine (Phila Pa 1976). 2009; 34(17):1869-72. DOI: 10.1097/BRS.0b013e3181adc989. View

Romano P, Chan B, Schembri M, Rainwater J . Can administrative data be used to compare postoperative complication rates across hospitals?. Med Care. 2002; 40(10):856-67. DOI: 10.1097/00005650-200210000-00004. View

Pugely A, Callaghan J, Martin C, Cram P, Gao Y . Incidence of and risk factors for 30-day readmission following elective primary total joint arthroplasty: analysis from the ACS-NSQIP. J Arthroplasty. 2013; 28(9):1499-504. DOI: 10.1016/j.arth.2013.06.032. View

Deyo R, Taylor V, Diehr P, Conrad D, Cherkin D, Ciol M . Analysis of automated administrative and survey databases to study patterns and outcomes of care. Spine (Phila Pa 1976). 1994; 19(18 Suppl):2083S-2091S. DOI: 10.1097/00007632-199409151-00011. View

Faciszewski T, Broste S, Fardon D . Quality of data regarding diagnoses of spinal disorders in administrative databases. A multicenter study. J Bone Joint Surg Am. 1997; 79(10):1481-8. DOI: 10.2106/00004623-199710000-00004. View

Lin H, Xirasagar S, Tang C . Costs per discharge and hospital ownership under prospective payment and cost-based reimbursement systems in Taiwan. Health Policy Plan. 2004; 19(3):166-76. DOI: 10.1093/heapol/czh020. View

10.

Tsai Y, Hu T . National health insurance, physician financial incentives, and primary cesarean deliveries in Taiwan. Am J Public Health. 2002; 92(9):1514-7. PMC: 1447270. DOI: 10.2105/ajph.92.9.1514. View

11.

Carragee E . The increasing morbidity of elective spinal stenosis surgery: is it necessary?. JAMA. 2010; 303(13):1309-10. DOI: 10.1001/jama.2010.402. View

12.

Shubert C, Habermann E, Bergquist J, Thiels C, Thomsen K, Kremers W . A NSQIP Review of Major Morbidity and Mortality of Synchronous Liver Resection for Colorectal Metastasis Stratified by Extent of Liver Resection and Type of Colorectal Resection. J Gastrointest Surg. 2015; 19(11):1982-94. DOI: 10.1007/s11605-015-2895-z. View

13.

Tang H, Zhu J, Ji F, Wang S, Xie Y, Fei H . Risk factors for postoperative complication after spinal fusion and instrumentation in degenerative lumbar scoliosis patients. J Orthop Surg Res. 2014; 9(1):15. PMC: 3995926. DOI: 10.1186/1749-799X-9-15. View

14.

Schairer W, Carrer A, Deviren V, Hu S, Takemoto S, Mummaneni P . Hospital readmission after spine fusion for adult spinal deformity. Spine (Phila Pa 1976). 2013; 38(19):1681-9. DOI: 10.1097/BRS.0b013e31829c08c9. View

15.

Guzman J, Skovrlj B, Shin J, Hecht A, Qureshi S, Iatridis J . The impact of diabetes mellitus on patients undergoing degenerative cervical spine surgery. Spine (Phila Pa 1976). 2014; 39(20):1656-65. PMC: 4161655. DOI: 10.1097/BRS.0000000000000498. View

16.

Guzman J, Iatridis J, Skovrlj B, Cutler H, Hecht A, Qureshi S . Outcomes and complications of diabetes mellitus on patients undergoing degenerative lumbar spine surgery. Spine (Phila Pa 1976). 2014; 39(19):1596-604. PMC: 4149698. DOI: 10.1097/BRS.0000000000000482. View

17.

Wang S, Zhang J, Qiu G, Wang Y, Li S, Zhao Y . Dual growing rods technique for congenital scoliosis: more than 2 years outcomes: preliminary results of a single center. Spine (Phila Pa 1976). 2012; 37(26):E1639-44. DOI: 10.1097/BRS.0b013e318273d6bf. View

18.

Xirasagar S, Lin H . Cost convergence between public and for-profit hospitals under prospective payment and high competition in Taiwan. Health Serv Res. 2004; 39(6 Pt 2):2101-16. PMC: 1361114. DOI: 10.1111/j.1475-6773.2004.00334.x. View

19.

Weinstein J, Lurie J, Tosteson T, Tosteson A, Blood E, Abdu W . Surgical versus nonoperative treatment for lumbar disc herniation: four-year results for the Spine Patient Outcomes Research Trial (SPORT). Spine (Phila Pa 1976). 2008; 33(25):2789-800. PMC: 2756172. DOI: 10.1097/BRS.0b013e31818ed8f4. View

20.

Amin B, Tu T, Schairer W, Na L, Takemoto S, Berven S . Pitfalls of calculating hospital readmission rates based on nonvalidated administrative data sets: : presented at the 2012 Joint Spine Section Meeting: clinical article. J Neurosurg Spine. 2012; 18(2):134-8. DOI: 10.3171/2012.10.SPINE12559. View