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

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

Research output: Contribution to journalArticle

11 Scopus citations

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

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

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

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