Introduction: Reducing readmissions is associated with increased patient safety.The impact of inpatient post-hospital care in preventing readmissions in the spine surgery population is unknown. The aim of the study is to understand the relationship between discharge destination and readmission rates after spine surgery.

Methods: A total of 1631 patients enrolled in a prospective longitudinal registry and undergoing elective surgery for cervical and lumbar degenerative spine over a period of four-years were included in the study.Readmission rates at 30 days, reasons for readmission,clinical, and baseline PRO instruments:leg and back pain, ODI, SF-12, and EQ-5D were recorded.

Results: A total of 1444(89%) patients were discharged home and 187(11%) patients discharged to an inpatient facility. In total, 65(4%) patients were readmitted at 30 days. At 30 days there was a similar incidence of readmissions within the patients discharged to an inpatient facility 10(5%) versus patients discharged home 55(4%)(p<0.2). Patients discharged home were significantly younger with an average age of 58 years versus 67 years for the patients discharged to an inpatient facility(P<0.0001). Patients discharged to an inpatient facility had a significantly lower ambulation rate,higher comorbidities,longer hospital stay,longer surgery time,higher complication rate,and worse baseline PRO scores.The predominant causes of readmission for patients discharged home included wound(67%) and medical(27%) complications. In contrast, medical complications(80%) were the main reason for readmission in those discharged to a facility.The readmissions related to surgical wound and medical complications were significant higher in patients that were discharged home versus to an inpatient facility(P<0.034,P<0.002,respectively)

Conclusions: Patients discharged to an inpatient facility had comparable readmission rates as to those discharged home,even though the former were an older and sicker population.Therefore,inpatient post-hospital care may reduce readmission in a high risk group of patients. Identifying these patients preoperatively will help guide expectations and begin the placement process so as to not prolong length of stay in the hospital.

Patient Care: This clinical research demonstrated the important role of inpatient post-hospital care in preventing readmissions in patients after spine surgery. With this study we will be able to justify early inpatient post-operative discharges in this group of patients. This will reduce hospital cost, length of stay and post-operative complications.

Learning Objectives: 1. To understand the importance of readmission in patient safety and satisfaction. 2. To understand the role of inpatient post-hospital care in preventing readmissions after spine surgery.

References: 1. Arbaje AI, Wolff JL, Yu Q, Powe NR, Anderson GF, Boult C. Postdischarge environmental and socioeconomic factors and the likelihood of early hospital readmission among community-dwelling Medicare beneficiaries. The Gerontologist 2008;48:495-504. 2. Aujesky D, Mor MK, Geng M, Stone RA, Fine MJ, Ibrahim SA. Predictors of early hospital readmission after acute pulmonary embolism. Archives of internal medicine 2009;169:287-93. 3. Basques BA, Webb ML, Bohl DD, Golinvaux NS, Grauer JN. Adverse Events, Length of Stay, and Readmission Following Surgery for Tibial Plateau Fractures. Journal of orthopaedic trauma 2014. 4. Clancy CM. Reengineering hospital discharge: a protocol to improve patient safety, reduce costs, and boost patient satisfaction. American journal of medical quality : the official journal of the American College of Medical Quality 2009;24:344-6. 5. Courtney MD, Edwards HE, Chang AM, et al. Improved functional ability and independence in activities of daily living for older adults at high risk of hospital readmission: a randomized controlled trial. Journal of evaluation in clinical practice 2012;18:128-34. 6. Crotty M, Giles LC, Halbert J, Harding J, Miller M. Home versus day rehabilitation: a randomised controlled trial. Age and ageing 2008;37:628-33. 7. Eastwood CA, Howlett JG, King-Shier KM, McAlister FA, Ezekowitz JA, Quan H. Determinants of early readmission after hospitalization for heart failure. The Canadian journal of cardiology 2014;30:612-8. 8. Garrison GM, Mansukhani MP, Bohn B. Predictors of thirty-day readmission among hospitalized family medicine patients. Journal of the American Board of Family Medicine : JABFM 2013;26:71-7. 9. Hain DJ, Tappen R, Diaz S, Ouslander JG. Characteristics of older adults rehospitalized within 7 and 30 days of discharge: implications for nursing practice. Journal of gerontological nursing 2012;38:32-44. 10. Hasan O, Meltzer DO, Shaykevich SA, et al. Hospital readmission in general medicine patients: a prediction model. Journal of general internal medicine 2010;25:211-9. 11. Iloabuchi TC, Mi D, Tu W, Counsell SR. Risk factors for early hospital readmission in low-income elderly adults. Journal of the American Geriatrics Society 2014;62:489-94. 12. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. The New England journal of medicine 2009;360:1418-28. 13. Kariv Y, Wang W, Senagore AJ, Hammel JP, Fazio VW, Delaney CP. Multivariable analysis of factors associated with hospital readmission after intestinal surgery. American journal of surgery 2006;191:364-71. 14. Lavernia CJ, Villa JM, Iacobelli DA. Readmission rates in the state of Florida: a reflection of quality? Clinical orthopaedics and related research 2013;471:3856-62. 15. Rahman M, Zinn JS, Mor V. The impact of hospital-based skilled nursing facility closures on rehospitalizations. Health services research 2013;48:499-518. 16. Vaziri S, Cox JB, Friedman WA. Readmissions in neurosurgery: a qualitative inquiry. World neurosurgery 2014;82:376-9.