Introduction: Resection of spinal tumors can greatly improve the quality of life for metastatic disease and facilitate cure of primary spine tumors. With the rise in healthcare costs there is increasing effort to maximize the value of care provided. Unplanned hospital readmissions are costly and may not be reimbursed in the future. Baseline rates from high volume centers are necessary to help establish quality standards. This study investigates readmission rates and risk factors for readmission after spine surgery for neoplastic disease.
Methods: This retrospective single-center study included patients from 2005 to 2011 with resection of metastatic or primary tumor of the spine. All patients underwent chart review to identify unplanned hospital readmissions, causes, and risk factors for readmission. Patients were grouped by primary or metastatic tumor, and by Tokuhashi primary site subscore (0=worst prognosis, 5=best prognosis). Readmission rates were calculated using Kaplan-Meier time-to-failure analysis.
Results: 185 patients included: 38 with primary, 147 with metastatic tumor. The one-year readmission rate estimate was 21.1% (n=8) for primary patients and 32.0% (n=47) for metastatic patients (Figure 1a, p = 0.014). Readmissions related to spine surgery accounted for 70.1% (n=39) of readmissions. Metastatic tumors with a worse Takahashi primary site subscore showed higher readmissions (Figure 1b, p = 0.002). Overall, factors associated with readmission were malignant tumor and metastatic tumor (p<0.05). Additionally, preoperative difficulty ambulating and discharge to a rehabilitation facility both showed a trend towards higher readmission, while preoperative radiation therapy trended towards lower readmission (p < 0.10).
Conclusions: Treatment of metastatic and malignant disease of the spine is associated with relatively high unplanned readmission rates. Additionally, site of primary tumor was associated with readmission rate; highly aggressive tumors (lung, osteosarcoma, stomach, bladder, esophagus, and pancreas) had the highest readmission rate. This information may be useful in setting baseline quality metrics and counseling patients and their families.
Patient Care: This information may be useful in setting baseline quality metrics and counseling patients and their families about the possibility of unplanned hospitlizations.
Learning Objectives: 1) Describe the unplanned readmission rates for treating patients with primary and metastatic spine tumor
2) Discuss, in small groups, the important role physicians have in helping to shape health policy standards
3) Identify high-risk patients for unplanned readmission by identifying pertinent risk factors
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