90-day Readmission after Lumbar Spinal Fusion Surgery in New York State between 2005 and 2014–A 10-year Analysis of a Statewide Cohort

Ali A. Baaj, Gernot Lang, Wei Chun Hsu, Mauricio J. Avila, Jialin Mao, Art Sedrakyan

Research output: Research - peer-reviewArticle

Abstract

STUDY DESIGN.: Retrospective cohort study. OBJECTIVE.: To assess 90-day readmission and evaluate risk factors associated with readmission after lumbar fusion in New York State. SUMMARY OF BACKGROUND DATA.: Readmission is becoming an important metric for quality and efficiency of healthcare. Readmission and its predictors following spine surgery are overall poorly understood and limited evidence is available specifically in lumbar fusion. METHODS.: The New York Statewide Planning and Research Cooperative System (SPACRS) was utilized to capture patients undergoing lumbar fusion from 2005–2014. Temporal trend of 90-day readmission was assessed using Cochran-Armitage test. Logistic regression was used to examine predictors associated with 90-day readmission. RESULTS.: There were 86,869 patients included in this cohort study. The overall 90-day readmission rate was 24.8%. On a multivariable analysis model, age (OR comparing ≥75 versus <35 years: 1.24, 95% CI: 1.13–1.35), sex (OR female to male: 1.19 (1.15–1.23)), race (OR African American to white: 1.60 (1.52–1.69)), insurance (OR Medicaid to Medicare: 1.42 (1.33–1.53)), procedure (OR comparing thoracolumbar fusion, combined (ICD-9: 81.04) to posterior lumbar interbody fusion / transforaminal lumbar spinal fusion (ICD-9: 81.08): 2.10 (1.49–2.97)), number of operated spinal levels (OR comparing 4–8 vertebrae to 2–3 vertebrae: 2.39 (2.07–2.77)), health service area ((HSA); OR comparing PA to Finger Lakes: 0.67 (0.61–0.73)), and comorbidity, i.e. coronary artery disease (OR: 1.26 (1.19–1.33)) were significantly associated with 90-day readmission. Direction of the odds ratios for these factors were consistent after stratification by procedure type. CONCLUSION.: Age, sex, race, insurance, procedure, number of operated spinal levels, HSA, and comorbidities are major risk factors for 90-day readmission. Our study allows risk calculation to determine high risk patients before undergoing spinal fusion surgery in order to prevent early readmission, improve quality of care and reduce health care expenditures.Level of Evidence: 3

LanguageEnglish (US)
JournalSpine
DOIs
StateAccepted/In press - Apr 24 2017
Externally publishedYes

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Spinal Fusion
antineoplaston A10
Spine
Catchment Area (Health)
Quality of Health Care
International Classification of Diseases
Insurance
Comorbidity
Cohort Studies
Medicaid
Lakes
Health Expenditures
Medicare
African Americans
Health Status
Fingers
Coronary Artery Disease
Retrospective Studies
Logistic Models
Odds Ratio

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

90-day Readmission after Lumbar Spinal Fusion Surgery in New York State between 2005 and 2014–A 10-year Analysis of a Statewide Cohort. / Baaj, Ali A.; Lang, Gernot; Hsu, Wei Chun; Avila, Mauricio J.; Mao, Jialin; Sedrakyan, Art.

In: Spine, 24.04.2017.

Research output: Research - peer-reviewArticle

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title = "90-day Readmission after Lumbar Spinal Fusion Surgery in New York State between 2005 and 2014–A 10-year Analysis of a Statewide Cohort",
abstract = "STUDY DESIGN.: Retrospective cohort study. OBJECTIVE.: To assess 90-day readmission and evaluate risk factors associated with readmission after lumbar fusion in New York State. SUMMARY OF BACKGROUND DATA.: Readmission is becoming an important metric for quality and efficiency of healthcare. Readmission and its predictors following spine surgery are overall poorly understood and limited evidence is available specifically in lumbar fusion. METHODS.: The New York Statewide Planning and Research Cooperative System (SPACRS) was utilized to capture patients undergoing lumbar fusion from 2005–2014. Temporal trend of 90-day readmission was assessed using Cochran-Armitage test. Logistic regression was used to examine predictors associated with 90-day readmission. RESULTS.: There were 86,869 patients included in this cohort study. The overall 90-day readmission rate was 24.8%. On a multivariable analysis model, age (OR comparing ≥75 versus <35 years: 1.24, 95% CI: 1.13–1.35), sex (OR female to male: 1.19 (1.15–1.23)), race (OR African American to white: 1.60 (1.52–1.69)), insurance (OR Medicaid to Medicare: 1.42 (1.33–1.53)), procedure (OR comparing thoracolumbar fusion, combined (ICD-9: 81.04) to posterior lumbar interbody fusion / transforaminal lumbar spinal fusion (ICD-9: 81.08): 2.10 (1.49–2.97)), number of operated spinal levels (OR comparing 4–8 vertebrae to 2–3 vertebrae: 2.39 (2.07–2.77)), health service area ((HSA); OR comparing PA to Finger Lakes: 0.67 (0.61–0.73)), and comorbidity, i.e. coronary artery disease (OR: 1.26 (1.19–1.33)) were significantly associated with 90-day readmission. Direction of the odds ratios for these factors were consistent after stratification by procedure type. CONCLUSION.: Age, sex, race, insurance, procedure, number of operated spinal levels, HSA, and comorbidities are major risk factors for 90-day readmission. Our study allows risk calculation to determine high risk patients before undergoing spinal fusion surgery in order to prevent early readmission, improve quality of care and reduce health care expenditures.Level of Evidence: 3",
author = "Baaj, {Ali A.} and Gernot Lang and Hsu, {Wei Chun} and Avila, {Mauricio J.} and Jialin Mao and Art Sedrakyan",
year = "2017",
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doi = "10.1097/BRS.0000000000002208",
journal = "Spine",
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TY - JOUR

T1 - 90-day Readmission after Lumbar Spinal Fusion Surgery in New York State between 2005 and 2014–A 10-year Analysis of a Statewide Cohort

AU - Baaj,Ali A.

AU - Lang,Gernot

AU - Hsu,Wei Chun

AU - Avila,Mauricio J.

AU - Mao,Jialin

AU - Sedrakyan,Art

PY - 2017/4/24

Y1 - 2017/4/24

N2 - STUDY DESIGN.: Retrospective cohort study. OBJECTIVE.: To assess 90-day readmission and evaluate risk factors associated with readmission after lumbar fusion in New York State. SUMMARY OF BACKGROUND DATA.: Readmission is becoming an important metric for quality and efficiency of healthcare. Readmission and its predictors following spine surgery are overall poorly understood and limited evidence is available specifically in lumbar fusion. METHODS.: The New York Statewide Planning and Research Cooperative System (SPACRS) was utilized to capture patients undergoing lumbar fusion from 2005–2014. Temporal trend of 90-day readmission was assessed using Cochran-Armitage test. Logistic regression was used to examine predictors associated with 90-day readmission. RESULTS.: There were 86,869 patients included in this cohort study. The overall 90-day readmission rate was 24.8%. On a multivariable analysis model, age (OR comparing ≥75 versus <35 years: 1.24, 95% CI: 1.13–1.35), sex (OR female to male: 1.19 (1.15–1.23)), race (OR African American to white: 1.60 (1.52–1.69)), insurance (OR Medicaid to Medicare: 1.42 (1.33–1.53)), procedure (OR comparing thoracolumbar fusion, combined (ICD-9: 81.04) to posterior lumbar interbody fusion / transforaminal lumbar spinal fusion (ICD-9: 81.08): 2.10 (1.49–2.97)), number of operated spinal levels (OR comparing 4–8 vertebrae to 2–3 vertebrae: 2.39 (2.07–2.77)), health service area ((HSA); OR comparing PA to Finger Lakes: 0.67 (0.61–0.73)), and comorbidity, i.e. coronary artery disease (OR: 1.26 (1.19–1.33)) were significantly associated with 90-day readmission. Direction of the odds ratios for these factors were consistent after stratification by procedure type. CONCLUSION.: Age, sex, race, insurance, procedure, number of operated spinal levels, HSA, and comorbidities are major risk factors for 90-day readmission. Our study allows risk calculation to determine high risk patients before undergoing spinal fusion surgery in order to prevent early readmission, improve quality of care and reduce health care expenditures.Level of Evidence: 3

AB - STUDY DESIGN.: Retrospective cohort study. OBJECTIVE.: To assess 90-day readmission and evaluate risk factors associated with readmission after lumbar fusion in New York State. SUMMARY OF BACKGROUND DATA.: Readmission is becoming an important metric for quality and efficiency of healthcare. Readmission and its predictors following spine surgery are overall poorly understood and limited evidence is available specifically in lumbar fusion. METHODS.: The New York Statewide Planning and Research Cooperative System (SPACRS) was utilized to capture patients undergoing lumbar fusion from 2005–2014. Temporal trend of 90-day readmission was assessed using Cochran-Armitage test. Logistic regression was used to examine predictors associated with 90-day readmission. RESULTS.: There were 86,869 patients included in this cohort study. The overall 90-day readmission rate was 24.8%. On a multivariable analysis model, age (OR comparing ≥75 versus <35 years: 1.24, 95% CI: 1.13–1.35), sex (OR female to male: 1.19 (1.15–1.23)), race (OR African American to white: 1.60 (1.52–1.69)), insurance (OR Medicaid to Medicare: 1.42 (1.33–1.53)), procedure (OR comparing thoracolumbar fusion, combined (ICD-9: 81.04) to posterior lumbar interbody fusion / transforaminal lumbar spinal fusion (ICD-9: 81.08): 2.10 (1.49–2.97)), number of operated spinal levels (OR comparing 4–8 vertebrae to 2–3 vertebrae: 2.39 (2.07–2.77)), health service area ((HSA); OR comparing PA to Finger Lakes: 0.67 (0.61–0.73)), and comorbidity, i.e. coronary artery disease (OR: 1.26 (1.19–1.33)) were significantly associated with 90-day readmission. Direction of the odds ratios for these factors were consistent after stratification by procedure type. CONCLUSION.: Age, sex, race, insurance, procedure, number of operated spinal levels, HSA, and comorbidities are major risk factors for 90-day readmission. Our study allows risk calculation to determine high risk patients before undergoing spinal fusion surgery in order to prevent early readmission, improve quality of care and reduce health care expenditures.Level of Evidence: 3

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