Introduction: Considerable controversy has surfaced regarding patients’ developing a hospital-acquired condition (HAC) postoperatively and they are associated with inferior patient outcomes. The three most common conditions are surgical site infections (SSI), deep vein thromboembolism (VTE), and urinary tract infections (UTI). The most common surgical procedure of the cervical spine is ACDF and consistent risk factors for these postoperative events have not been identified utilizing a large database.
Methods: This was a retrospective analysis of prospectively collected data from the NSQIP database of patients > 18 years old undergoing elective ACDF between 2005 and 2012. Patient baseline factors, perioperative data, preoperative labs, and postoperative course were recorded. Patients with SSI, VTE, or UTI were compared using multivariate logistic regression analysis with significance defined as p < 0.05. Odds ratio (OR) was calculated with a 95% confidence interval.
Results: 3,845 patients met inclusion criteria with 50.3% of patients male and 80.5% performed as inpatient procedures. Overall rate of HAC was 1.7% (66/3845). Regression analysis showed independent predictors of HAC's were American Society of Anesthesiologists (ASA) score >/= 3 (OR 1.9, 1.2-3.2), history of stroke (OR 3.1, 1.2-8.5) and operative time > 4 hours (OR 2.8, 1.4-5.5). BMI, diabetes, smoking, prior functional status, other comorbidities, and multilevel fusions were not significant for developing HAC’s (p> 0.05). Patients with HAC had a higher rate of mortality (0.2% vs 1.5%, p=0.04), reoperation (1.5% vs 21.2%, p<0.0001), longer length of stay (LOS) > 5 days (5.4% vs 28.8%, p<0.0001) and readmission (1.2% vs 10.6%, p<0.0001).
Conclusions: Risk factors for the development of a HAC's following ACDF were higher ASA scores, history of stroke and prolonged operative time. Developing a HAC was associated with higher rates of mortality, reoperation and readmission. This demonstrates a combination of perioperative variables that need careful consideration during surgical planning and medical optimization.
Patient Care: Better understanding risk factors for HAC will help physicians provide patient-centered care aimed at reducing the incidence of HAC in ACDF patients.
Learning Objectives: By the conclusion of this session, participants should be able to understand risk factors for HAC in patients undergoing ACDF.