Introduction: Identifying causes and risk factors of readmission in the elderly is necessary to reduce the soaring readmission rates and healthcare costs. The aim of this is to determine if post-operative delirium in the elderly is an independent risk factor for 30-day hospital readmission after spine surgery.
Methods: Medical records of 453 consecutive elderly (=65 years old) patients undergoing spine surgery at DUMC from 2008 to 2010 were reviewed. We identified 17(3.75%) patients who experienced post-operative delirium according to DSM-V criteria (No Delirium:436, Delirium:17). Patient demographics, comorbidities, and post-operative complication rates were collected on all patients. The association between post-operative delirium and 30-day readmission rate was assessed via multivariate logistic regression analysis.
Results: Patient demographics and comorbidities were similar between both groups. Elderly patients experiencing post-operative delirium have an increased length of hospital stay (10.47 days vs. 5.70 days,p=0.0097). Complication rates were similar between the cohorts with the post-operative delirium patients having increased UTI and superficial surgical site infections. Total, 12.14% of patients were re-admitted within 30-days of discharge, with post-operative delirium patients experiencing approximately a 4-fold increase in 30-day readmission rates (Delirium: 41.18% vs. No Delirium: 11.01%,p=0.0020). Of the patients experiencing post-operative delirium, 35.29% had a history of depression and 23.53% had a history of anxiety prior to hospitalization. The average number days until post-operative delirium was 5.88 days, and the most common treatment for the delirium was discontinuing the patients’ narcotics(29.4%). In a multivariate logistic regression analysis for risk factors of 30-day readmission, demonstrated that post-operative delirium is an independent predictor of 30-day readmission after spine surgery in the elderly(p=0.0314). Furthermore, elderly patients who experience post-operative delirium after spine surgery have a significantly higher risk of an unplanned 30-day hospital readmission.
Conclusions: Elderly patients experiencing post-operative delirium after spine surgery is an independent risk factor for unplanned readmission within 30-days of discharge.
Patient Care: Our research will shed light into a growing prevalence of post-operative delirium in the elderly after spine surgery and make aware of the extra health care expenditures via 30-day readmission rates.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Describe the effects of post-operative delirium in the Elderly on 30-day readmission rates.
2) Discuss and Identify in small groups ways to prevent post-operative delirium in the Elderly after spine surgery.