Most 30-day Readmissions After Anterior Cervical Discectomy and Fusion are Not Due to Surgical Site-Related Issues: An Analysis of 17,088 Patients.

Most 30-day Readmissions After Anterior Cervical Discectomy and Fusion are Not Due to Surgical Site-Related Issues: An Analysis of 17,088 Patients.

Spine (Phila Pa 1976). 2016 Jul 7;

Authors: Samuel AM, Fu MC, Toy JO, Lukasiewicz AM, Webb ML, Bohl DD, Basques BA, Albert TJ, Grauer JN

Abstract
STUDY DESIGN: A retrospective study of patients undergoing anterior cervical discectomy and fusion (ACDF) in the prospective National Surgical Quality Improvement Program (NSQIP) database.
OBJECTIVE: To determine the most common reasons for readmission within 30 days after elective ACDF.
SUMMARY OF BACKGROUND DATA: ACDF is a commonly performed surgery that is safe and effective for treating a variety of cervical spine pathologies. However, with new quality-based reimbursements tied to readmissions within 30 days of discharge, better understanding of the causes of readmissions is needed.
METHODS: Patients undergoing ACDF in the NSQIP database from 2012 - 2014 were reviewed. The overall rate of readmission and documented reasons for readmission were collected. Multivariate regression was then used to determine risk factors for readmissions.
RESULTS: A total of 17,088 patients undergoing elective ACDF were identified. There were 545 (3.2%) readmissions within 30 postoperative days. Of the readmitted patients, 293 (53.8%) were readmitted for non-surgical site related reasons, with neuropsychiatric (n = 44), cardiovascular (n = 39) and pneumonia (n = 37) being the most common reasons. A total of 184 patients (33.8%) were readmitted for surgical-site related reasons, with surgical site infection (n = 42), hemorrhage/hematoma (n = 42), and dysphagia (n = 32) being the most common reasons. A total of 84 patients (15.6%) had undocumented reasons for readmission. In multivariate analysis, only older age and higher ASA class were independently associated with readmissions.
CONCLUSIONS: Most readmissions after ACDF were due to non-surgical site related reasons, suggesting the importance of careful patient selection, aggressive preoperative medical optimization, and adequate postoperative management.
LEVEL OF EVIDENCE: 3.

PMID: 27398892 [PubMed - as supplied by publisher]

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