National Rates, Causes, Risk Factors, and Outcomes Associated With 30-Day and 90-Day Readmissions Following Degenerative Posterior Cervical Spine Surgery Utilizing the Nationwide Readmissions Database

• Published in: Neurosurgery Vol. 81; no. 5; pp. 740 - 751
• Main Authors: Rumalla, Kavelin, Smith, Kyle A, Arnold, Paul M
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01.11.2017; Copyright by the Congress of Neurological Surgeons; Wolters Kluwer Health, Inc
• Subjects: Degenerative disc disease; Risk factors; Surgery; NRD; Posterior cervical spinal surgery; Cervical surgery; HCUP; AHRQ; Readmission; Degenerative cervical spine
• ISSN: 0148-396X; 1524-4040
• DOI: 10.1093/neuros/nyx063

Abstract BACKGROUND Hospital readmissions have profound financial and clinical impacts. Analyses of 30-day readmissions following spine surgery have been previously reported utilizing administrative databases. However, time periods outside the initial 30 days have not been well studied. Furthermore, these databases have limitations regarding coding and institutional crossover. OBJECTIVE The authors sought to analyze 30-day and 90-day readmission rates and risk factors using the Nationwide Readmissions Database (NRD) in a retrospective cohort receiving elective, posterior cervical spine surgery for degenerative conditions. METHODS NRD is a new source containing approximately 50% of US hospitalizations, with patient-linkage numbers to longitudinally track patients. Patients 18 years of age or older were identified. Preoperative characteristics, demographics, and surgical characteristics were chosen for predictor variables. Thirty-day and 90-day readmission rates were calculated. Statistical analysis was completed using SPSS v.23 software via univariate and multivariate analyses. RESULTS Between January and September 2013, a total of 29 990 patients were identified. Readmission rates for 30- and 90-days were 5.4% and 10.0%, respectively. The most common reason for readmission during 30-day and 90-day periods was complications of surgical and/or medical care (31.0% vs 21.9%, respectively). The strongest risk factors for 30-day readmission included wound dehiscence, weekend admission at index hospitalization, coagulopathy, and incidental durotomy. The strongest risk factors for 90-day readmission included thromboembolic complications, postoperative hemorrhage, and comorbidities. CONCLUSION Identification of predictors of readmission is important to allow for changes in perioperative management to potentially reduce readmissions and improve outcomes. Additionally, knowledge about readmission risk factors allows for preoperative counseling.