Risk Factors for 30- and 90-Day Readmissions Due To Surgical Site Infection Following Posterior Lumbar Fusion

Abstract

Objective: Identify the independent risk factors for 30-and 90-day readmission because of surgical site infection (SSI) in patients undergoing elective posterior lumbar fusion (PLF).Summary of Background Data: SSI is a significant cause of morbidity in the 30-and 90-day windows after hospital discharge. There remains a gap in the literature on independent risk factors for readmission because of SSI after PLF procedures. In addition, readmission for SSI after spine surgery beyond the 30-day postoperative period has not been well studied.Methods: A retrospective analysis was performed on data from the 2012 to 2014 Healthcare Cost and Utilization Project Nationwide Readmissions Database. The authors identified 65,121 patients who underwent PLF. There were 191 patients (0.30%) readmitted with a diagnosis of SSI in the 30-day readmission window, and 283 (0.43%) patients readmitted with a diagnosis of SSI in the 90-day window. Baseline patient demographics and medical comorbidities were assessed. Bivariate and multivariate analyses were performed to examine the independent risk factors for readmission because of SSI.Results: In the 30-day window after discharge, this study identified patients with liver disease, uncomplicated diabetes, deficiency anemia, depression, psychosis, renal failure, obesity, and Medicaid or Medicare insurance as higher risk patients for unplanned readmission with a diagnosis of SSI. The study identified the same risk factors in the 90-day window with the addition of diabetes with chronic complications, chronic pulmonary disease, and pulmonary circulation disease.Conclusions: Independent risk factors for readmission because of SSI included liver disease, uncomplicated diabetes, obesity, and Medicaid insurance status. These findings suggest that additional intervention in the perioperative workup for patients with these risk factors may be necessary to lower unplanned readmission because of SSI after PLF surgery.

Risk Factors for 30-day Unplanned Readmission following Surgery for Lumbar Degenerative Diseases: A Systematic Review

“…Five studies investigated the risk of readmission in different races, 13 , 20 , 25 , 28 , 43 with Black patients exhibiting a significantly higher risk. The impact of obesity was analyzed in 10 7 , 8 , 18 , 25 , 28 , 30 , 31 , 39 - 41 studies, 5 8 , 18 , 28 , 30 , 39 , 41 of which reported obesity as a significant risk factor, 2 18 , 40 reported that body mass index (BMI) > 30 was associated with a higher risk of readmission and 1 30 found similar correlation using linear regression of BMI.…”

“… 32 , 35 , 36 , 42 Anemia was considered as a risk factor in 3 of the 4 studies where it was reported. 8 , 29 , 41 Chronic pulmonary disease (non-specified) was reported in 8 studies, 7 - 9 , 26 , 28 , 29 , 35 , 42 of which, Elsamadicy 8 and Jain 28 considered it as a significant risk factor. Among these studies, 5 reported a history of chronic obstructive pulmonary disease (COPD) 7 , 9 , 26 , 35 , 42 associated with readmission.…”

Clinical Outcomes at One-year Follow-up for Patients With Surgical Site Infection After Spinal Fusion

“…[7][8][9]17,18 While previous literature has focused on risk factors and measures to mitigate rates of postoperative infection, there is a dearth of evidence documenting how patients fair after spinal SSI. [28][29][30][31][32] To counsel patients and Copyright r 2022 Wolters Kluwer Health, Inc. All rights reserved.…”

Predicting the Surgical Site Infections in Patients Undergoing Lumbar Internal Fixation Surgery: A New Predictive Nomogram is Evelopmenting and Assessmenting

“…In lumbar spine surgery, obesity or BMI is mostly a risk factor for incisions infection after lumbar spine surgery, Since BMI may not re ect the composition of speci c parts of the body, in a prospective study, Emily Waisbren and others used percent body fat (%BF)( Body fat% = (1.20 × BMI) + (0.23 × age) − (10.8 × gender) − 5.4) as an independent risk factor, and think that unlike the traditional de nition of obesity, this type of obesity de ned by %BF is associated with a 5-fold increase in the risk of SSI, and this risk also increases with the increase of %BF, which is more sensitive and accurate than BMI SSI risk measurement, but further research is needed to better understand this relationship [33,34]. In our measurement, the thickness of the sebum in the lumbar spine surgery area is taken as the measurement value of the speci c part, this has a better guiding signi cance for the infection of the incision at the speci c surgical site.…”