Hospital Readmission After Spine Fusion for AdultSpinal Deformity

Schairer, William W.; Carrer, Alexandra; Deviren, Vedat; Hu, Serena S.; Takemoto, Steven K.; Mummaneni, Praveen V.; Chou, Dean; Ames, Christopher P.; Burch, Shane; Tay, Bobby; Sawyer, Aenor; Berven, Sigurd

doi:10.1097/brs.0b013e31829c08c9

Cited by 106 publications

(79 citation statements)

References 18 publications

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“…Schairer reported a 90 day unplanned readmission rate of 12.3% in patients who underwent deformity surgery in his study. 11 McCormack reported 30 day unplanned readmission rates of 4.3% for anterior cervical spine fusion patients and 5.9% for posterior cervical fusion patients from 2007 through 2009. 7 His study is of particular interest because it took place at the same institution as ours, yet it reported higher readmission rates than we observed from 2011 through 2014.…”

Section: Discussionmentioning

confidence: 99%

Ninety-day readmissions after degenerative cervical spine surgery: A single-center administrative database study

et al. 2015

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Background Unplanned hospital readmissions result in significant clinical and financial burdens to patients and the healthcare system. Readmission rates and causes have been investigated using large administrative databases which have certain limitations in data reporting and coding. The objective of this study was to provide a description of 90 day post-discharge readmissions following surgery for common degenerative cervical spine pathologies at a largevolume tertiary hospital. The study also compared the readmission rates of patients who underwent anterior-and posterior-approach procedures.

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Section: Discussionmentioning

confidence: 99%

Ninety-day readmissions after degenerative cervical spine surgery: A single-center administrative database study

et al. 2015

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“…The major complications we noted in our study were dural tears, intra-operative haemorrhage, wound sepsis and pseudarthrosis leading to instrumentation failure. Schairer et al 10 reported risk factors leading to complications requiring readmission were longer fusion length, higher patient severity of illness and specific medical comorbidities. Surgical site infection accounted for 45.6% of their 8.4% rate of readmission.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4] The decision to abort conservative management for surgical intervention can be difficult. Recent evidence has shown that surgically treated patients do better than conservatively managed ones in terms of pain and healthrelated quality of life (HRQOL) outcomes.…”

Section: Introductionmentioning

confidence: 99%

Multilevel lumbosacral fusions: Complications and patient-reported outcome

Moll¹,

Dunn²

2015

A orthop. j.

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The ageing population presents with debilitating back pain and leg pain with a background of adult spinal deformity, after a protracted period of conservative care. Sagittal balance is required to achieve a good clinical outcome; however, the surgery is associated with a high incidence of complications. Aim:To review the outcome of multilevel (≥4) instrumented lumbar fusion to sacrum/pelvis performed for degenerative conditions. Methods:A retrospective descriptive study of 47 consecutive patients from 2002 to 2012. Inclusion criterion was fusion from at least L2 to S1/pelvis, i.e. minimum of four levels. Imaging was assessed as to the restoration of normal sagittal profile as well as subsequent fusion. EQ5D, ODI and VAS scores pre-op and at 6 months post-op were analysed. Average age at surgery was 64 years (50-78). Thirteen cases were primary and 34 revisions. Indications were axial back pain either associated with sagittal imbalance (40%) or leg pain (36%) and leg pain alone in 10%. Results:The intra-operative blood loss averaged 2 222 (250-7 000) ml with 40% re-infusion from cell-saver. The average surgical duration was 268 minutes.Proximal extent of instrumentation was T2 (1), T3 (1), T4 (2), T8 (1), T9 (1), T10 (17), T11 (2), T12 (5), L1 (4) and L2 (13). TLIFs were done in 20 cases mostly at the base of the construct. Pedicle subtraction osteotomies were performed in 14 revision cases. Dural tears occurred in 14 cases, all revision cases except one. Wound infection occurred in three cases. With the exception of transient quadriceps weakness related to osteotomy, no neurological complications occurred. One patient died peri-operatively. Subsequent revision was required in 13 cases for instrumentation failure. The OSD score improved by 15.3 points on average, which is clinically and statistically significant. Conclusion:Long lumbar fusions remain technically demanding with a high incidence of adverse events. This is due to the nature of revision surgery and high biomechanical demands on constructs. Surgical intervention can however be justified by the desperation of the cohort in terms of pain and poor function which can be modestly improved with this intervention.

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“…These factors could contribute to different 30-day readmission rates based on subspecialty. Previous studies have shown a range of 30-day readmission rate from 3% for joint arthroplasty to 14% for spinal deformity surgery [26,28]. If there are differences across orthopaedic subspecialties in readmission rates, then CMS-driven disincentives may be applied unequally across subspecialties.…”

Section: Introductionmentioning

confidence: 99%

“…This could result in hospitals deemphasizing those service lines and, to the degree that some of these services (such as complex spine care or Level I trauma) are available mainly at tertiary care hospitals, those disincentives could result in limiting access to care to the neediest patients. Previous studies have identified risk factors for readmission in single institutions [9,26,28]. It has been demonstrated that risk factors for readmission vary according to patient population [2]; therefore, we aim to characterize the readmission risk factors in our large, academic, tertiary care hospital to add to the body of published data.…”

Section: Introductionmentioning

confidence: 99%

What Are the 30-day Readmission Rates Across Orthopaedic Subspecialties?

Bernatz

Tueting

Hetzel

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background The Centers for Medicare & Medicaid Services (CMS) now include hip and knee replacements in the Hospital Readmission Reduction Program. The 30-day readmission rate is an important quality metric; however, the incidence has not yet been defined across the numerous orthopaedic subspecialties. Elucidating the readmission rate for each subspecialty may indicate that certain services are being disincentivized by the CMS reimbursement program.

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Hospital Readmission After Spine Fusion for AdultSpinal Deformity

Cited by 106 publications

References 18 publications

Ninety-day readmissions after degenerative cervical spine surgery: A single-center administrative database study

Ninety-day readmissions after degenerative cervical spine surgery: A single-center administrative database study

Multilevel lumbosacral fusions: Complications and patient-reported outcome

What Are the 30-day Readmission Rates Across Orthopaedic Subspecialties?

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