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  • Does Inpatient Post-hospital Care Prevents Readmissions after Spine Surgery?

    Final Number:

    Raul A Vasquez-Castellanos MD; Silky Chotai MD; Thomas H. Freeman BS; Harrison F. Kay; Joseph S. Cheng MD, MS; Clinton J. Devin MD; Matthew J. McGirt MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    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.

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