Unplanned Hospital Readmission After Surgical Treatment of Common Lumbar Pathologies

Akamnonu, Chibuikem; Cheriyan, Thomas; Goldstein, Jeffrey A.; Lafage, Virginie; Errico, Thomas J.; Bendo, John A.

doi:10.1097/brs.0000000000000759

Cited by 48 publications

(27 citation statements)

References 10 publications

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“…Other authors have also reported that surgical site infections and wound complications were the most common reasons for readmission, making up to 46% to 72% of all readmissions during the 90-day discharge period. 5,32 In our study, the diagnosis of lung cancer and hospital stay longer than 15 days during the index hospitalization were independently associated with 90-day readmission, which is consistent with prior studies as well. 6 Other previously identified risk factors for readmission following spine surgery include malignancy, longer operative time, longer constructs, higher patient severity of illness, and surgical complications.…”

Section: Discussionsupporting

confidence: 92%

“…40 The reported 90-day readmission rate following various types of spine surgery (degenerative cervical spine to scoliosis deformity correction) ranges from 1.0% to 12.3%. 4,5,32 The 90-day readmission rate in our study falls into the higher range of the reported rates (11.6%), with average hospital readmission costs totaling $20,078. This cost is significant, especially when taking into account the number of patients who undergo spine tumor surgery.…”

Section: Discussioncontrasting

confidence: 45%

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Costs and readmission rates for the resection of primary and metastatic spinal tumors: a comparative analysis of 181 patients

Lau¹,

Chan²,

Theologis

et al. 2016

SPI

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OBJECTIVE Because the surgical strategies for primary and metastatic spinal tumors are different, the respective associated costs and morbidities associated with those treatments likely vary. This study compares the direct costs and 90-day readmission rates between the resection of extradural metastatic and primary spinal tumors. The factors associated with cost and readmission are identified. METHODS Adults (age 18 years or older) who underwent the resection of spinal tumors between 2008 and 2013 were included in the study. Patients with intradural tumors were excluded. The direct costs of index hospitalization and 90-day readmission hospitalization were evaluated. The direct costs were compared between patients who were treated surgically for primary and metastatic spinal tumors. The independent factors associated with costs and readmissions were identified using multivariate analysis. RESULTS A total of 181 patients with spinal tumors were included (63 primary and 118 metastatic tumors). Overall, the mean index hospital admission cost for the surgical management of spinal tumors was $52,083. There was no significant difference in the cost of hospitalization between primary ($55,801) and metastatic ($50,098) tumors (p = 0.426). The independent factors associated with higher cost were male sex (p = 0.032), preoperative inability to ambulate (p = 0.002), having more than 3 comorbidities (p = 0.037), undergoing corpectomy (p = 0.021), instrumentation greater than 7 levels (p < 0.001), combined anterior-posterior approach (p < 0.001), presence of a perioperative complication (p < 0.001), and longer hospital stay (p < 0.001). The perioperative complication rate was 21.0%. Of this cohort, 11.6% of patients were readmitted within 90 days, and the mean hospitalization cost of that readmission was $20,078. Readmission rates after surgical treatment for primary and metastatic tumors were similar (11.1% vs 11.9%, respectively) (p = 0.880). Prior hospital stay greater than 15 days (OR 6.62, p = 0.016) and diagnosis of lung metastasis (OR 52.99, p = 0.007) were independent predictors of readmission. CONCLUSIONS Primary and metastatic spinal tumors are comparable with regard to the direct costs of the index surgical hospitalization and readmission rate within 90 days. The factors independently associated with costs are related to preoperative health status, type and complexity of surgery, and postoperative course.

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Section: Discussionsupporting

confidence: 92%

Section: Discussioncontrasting

confidence: 45%

Costs and readmission rates for the resection of primary and metastatic spinal tumors: a comparative analysis of 181 patients

Lau¹,

Chan²,

Theologis

et al. 2016

SPI

View full text Add to dashboard Cite

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“…Incremental adjusted resources consumed by MB experiencing a specific study adverse event was the estimated using a dichotomous variable that was set equal to 1 if the patient experienced the adverse event of interest and set to 0 for all MB in the sample not experiencing any of the other study adverse events. These estimation approaches are similar to those used to estimate the incremental cost of treating adverse events associated with total knee arthroplasty 16 . Table 1 presents observed differences in baseline demographic and clinical characteristics for all MBs and by whether or not the MB experienced one or more of the study's adverse events.…”

Section: Strategy For Estimating Incremental Resource Usementioning

confidence: 99%

“…9 A number of articles have reported on mortality and selected adverse events associated with patients undergoing spinal fusion surgery [10][11][12][13][14] and other studies have examined length of stay 8,15 and unplanned readmission after spinal surgery. [16][17] However, only a few of these studies used a national sample of spinal surgery patients in the United States 8,11,[13][14][15] each adverse event. All adverse events reported in this study occurred during the operative hospitalization.…”

Section: Introductionmentioning

confidence: 99%

Incremental Hospital Cost and Length-of-Stay Associated With Treating Adverse Events Among Medicare Beneficiaries Undergoing Lumbar Spinal Fusion During Fiscal Year 2013

Culler

Jevsevar

Shea

et al. 2016

Spine

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“…With respect to spine surgery, the patient case mix for post-acute rehabilitative care is unclear and there are no established clinical practice guidelines for the post-discharge management of patients receiving lumbar spinal fusion surgery. The research to-date examining hospital readmissions among patients who received post-acute rehabilitative care is inconclusive (Akamnonu et al, 2015; Abt et al, 2017). …”

Section: Introductionmentioning

confidence: 99%

The association of discharge destination with 30-day rehospitalization rates among older adults receiving lumbar spinal fusion surgery

Cook

Coronado

Bettger

et al. 2018

Musculoskeletal Science and Practice

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Background: As defined by Medicare (United States), post-acute rehabilitation services include care provided in inpatient rehabilitation units and facilities, skilled nursing facilities, long-term acute hospitals, and by home health services. Methods: We retrospectively evaluated the use of rehabilitation-based post-acute services among Medicare beneficiaries who were hospitalized for lumbar spinal fusion (ICD-9-CM procedure codes 81.04–81.08) in 2012–2014, examined the case-mix for those discharged to rehabilitation- and non-rehabilitation based services, and determined the association between these categories of discharge disposition and 30-day rehospitalization. The independent effect of rehabilitation-based discharge destination on 30-day readmissions was examined with a generalized linear mixed model, first adjusting for patient characteristics and then stratified by clusters that delineated more homogenous clinical profiles. Results: Among 261,558 Medicare beneficiaries with lumbar spinal fusion surgery, 50.8% were discharged to a rehabilitation-based post-acute services. Patients discharged to rehabilitation-based services were older and had more comorbidities, and had longer hospital lengths of stays. After adjusting for patient and hospital characteristics, patients discharged to rehabilitation-based post-acute care had increased odds of 30-day rehospitalization than those without discharge to other destinations (OR 1.36; 95%CI=1.31, 1.40). Analysis of patients by clinical profile clusters found similar results. Conclusions: Clinical profiles of Medicare beneficiaries who had lumbar spinal fusion surgery and were discharged to rehabilitation-based post-acute services included more comorbidities than those discharged to non-rehabilitation based settings. Controlling for these differences did not mediate the negative association between use of rehabilitation-based post-acute services and 30-day readmission.

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Unplanned Hospital Readmission After Surgical Treatment of Common Lumbar Pathologies

Abstract: 4.

Cited by 48 publications

References 10 publications

Costs and readmission rates for the resection of primary and metastatic spinal tumors: a comparative analysis of 181 patients

Costs and readmission rates for the resection of primary and metastatic spinal tumors: a comparative analysis of 181 patients

Incremental Hospital Cost and Length-of-Stay Associated With Treating Adverse Events Among Medicare Beneficiaries Undergoing Lumbar Spinal Fusion During Fiscal Year 2013

The association of discharge destination with 30-day rehospitalization rates among older adults receiving lumbar spinal fusion surgery

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