Introduction: Elective lumbar fusion is being performed with greater frequency in recent years. However, little is known as to what factors are predictors of readmission in this population. Readmissions and complications are not only detrimental to operative success and outcomes, but also pose a significant strain on healthcare resources.
Methods: Adult patients 18 years of age and older undergoing elective lumbar spine fusion from 2011-2012 were identified by CPT (Current Procedural Terminology) code in the ACS NSQIP database. Patients with unplanned readmissions were identified. Patient demographics and operative complications were analyzed. Univariate statistical analysis was performed and multivariate model was performed to analyze independent patient characteristics and comorbidities that lead to unplanned readmissions with p < 0.05 being significant. Odds ratio were performed with 95% confidence interval.
Results: National readmission rate for elective lumbar spinal fusion was 5.2%. Patients with history of cardiac surgery, peripheral vascular disease, length of stay > 5 days and multilevel fusions were readmitted with greater frequency. Patients with 1 or more perioperative complications were also more likely to be readmitted (59.5% vs 22.3% not readmitted, p < 0.0001). Multivariate model revealed insulin dependent diabetes (OR=2.3), bleeding disorder (OR=3.3), LOS >5 days (OR=1.7), and multilevel fusion (OR=1.4) to be significant independent factors for unplanned 30 day readmission in this cohort.
Conclusions: Patients with medical comorbidities such as diabetes and bleeding disorders are at a significantly higher risk of being readmitted. This information may assist spine surgeons when performing risk stratification of patients at risk of readmission.
Patient Care: Understanding the significance of diabetes and bleeding disorders before undergoing adult deformity surgery is important for provider and patient.
Learning Objectives: Our objective was to analyze risk factors for unplanned readmission in adults undergoing adult deformity surgery. Our hypothesis is that patients with certain comorbidities and perioperative complications are at increased risk for unplanned readmissions after undergoing elective lumbar spine fusion.