Unplanned Readmission Is Associated With Decreased Overall Survival and Performance After Metastatic Spine Surgery

Abstract

Study Design. Retrospective case-control study. Objective. In a cohort of patients undergoing metastatic spine surgery, we sought to: (1) identify risk factors associated with unplanned readmission, and (2) determine the impact of an unplanned readmission on long-term outcomes. Summary of Background Data. Factors affecting readmission after metastatic spine surgery remain relatively unexplored. Materials and Methods. A single-center, retrospective, case-control study was undertaken of patients undergoing spine surgery for extradural metastatic disease between 02/2010 and 01/2021. The primary outcome was 3-month unplanned readmission. Preoperative, perioperative, and tumor-specific variables were collected. Multivariable Cox regression was performed, controlling for tumor size, other organ metastasis, and preoperative/postoperative radiotherapy/chemotherapy. Results. A total of 357 patients underwent surgery for spinal metastases with a mean follow-up of 538.7±648.6 days. Unplanned readmission within 3 months of surgery occurred in 64/357 (21.9%) patients, 37 (57.8%) were medical, 27 (42.2%) surgical, and 21 (77.7%) were related to their spine surgery. No significant differences were found regarding demographics and preoperative variables, except for insurance, where most readmitted patients had private insurance compared with nonreadmitted patients (P=0.021). No significant difference was found in preoperative radiotherapy/chemotherapy. Regarding perioperative exposure variables, readmitted patients had a higher rate of postoperative complications (68.8% vs. 24.2%, P<0.001) and worse postoperative Karnofsky Performance Score (P=0.021) and Modified McCormick Scale (P=0.015) at the time of first follow-up. On multivariate logistic regression, postoperative complications were associated with increased readmissions (odds ratio=1.38, 95% CI=1.25–1.52, P<0.001). Regarding the impact of unplanned readmission on long-term tumor control, unplanned readmission was associated with shorter time to local recurrence (log-rank; P=0.029) and reduced overall survival (OS) (log-rank; P<0.001). On multivariate Cox regression, other organ metastasis [hazard ratio (HR)=1.48, 95% CI=1.13–1.93, P=0.004] and 3-month readmission (HR=1.75, 95% CI=1.28–2.39, P<0.001) were associated with worsened OS, with no impact on LR. Postoperative chemotherapy was significantly associated with longer OS (HR=0.59, 95% CI=0.45–0.77, P<0.001). Conclusions. Postoperative complications were associated with unplanned readmission following metastatic spine surgery. Furthermore, 3-month unplanned readmission was associated with a shorter time to local recurrence and decreased OS. These results help surgeons understand the drivers of readmissions and the impact of readmissions on patient outcomes. Level of Evidence. 3.

Does Elective Admission vs. Emergency Department Presentation Affect Surgical Outcomes in Metastatic Spine Surgery?

“…The requirement of a more robust surgical intervention may be due in part to a higher tumor burden creating destruction to surrounding soft tissue and bone through local invasion, thus necessitating a more extensive decompression of neural elements. The most commonly reported complication of wound breakdown was in line with what our data suggests [10].…”

“…All patients underwent surgery in accordance with the strategy of separation surgery, consisting of spinal cord decompression and long-segment posterior stabilization and fusion [8][9][10][11]. Patients were most often taken for a posterior approach, potentially involving a transpedicular approach or costotransversectomy to achieve adequate spinal cord decompression.…”

Impact of Unplanned Readmission on Patient-Reported Outcomes After Cervical Spine Surgery: A National Study of 13 355 Patients

“…4 Furthermore, unplanned readmission is reported as a surrogate for worse outcomes in other disciplines of spine surgery, such as spine oncology, where patients with unplanned readmissions have higher chance of worse outcomes, including decreased overall survival. 10 The current study presented the impact of medical, surgical, and pain readmission categories and subcategories on PROMs. Our rationale for this granular presentation was to provide a detailed analysis for spine surgeons, enabling them to discern whether different readmission reasons were associated with worse used continuous enrollment of all eligible patients, while others used a rolling systematic enrollment of a limited number of patients per week meant to reduce, but not eliminate, bias in enrollment.…”

“…Although previous literature has extensively identified predictors of unplanned readmission after cervical spine surgery, there is a notable gap in exploring the specific reasons for unplanned readmissions on PROMs. [6][7][8][9] Furthermore, the occurrence of an unplanned readmission has been recognized as a surrogate of outcome and quality of care in several neurosurgical procedures, 10,11 but its impact remains understudied in cervical spine surgery. Therefore, it is valuable for patients, providers, and payers to understand the impact of unplanned readmission on long-term PROMs.…”

Does Low-Grade Versus High-Grade Bilsky Score Influence Local Recurrence and Overall Survival in Metastatic Spine Tumor Surgery?

“…Postoperative complications, length of stay (LOS), and discharge disposition were also recorded. Finally, postoperative outcomes included reoperation, 90-day readmission, 10,11 functional status as defined by Karnofsky Performance Scale (KPS) 12 and Mc-Cormick Scale (MMS), 13 LR, overall survival (OS) and 1-year survival. LR was assessed on serial MRI at 1 month, 6 months, and 1 year, and any available MRI thereafter.…”