Medical College of Wisconsin
CTSICores SearchResearch InformaticsREDCap

Thirty-day readmissions after elective spine surgery for degenerative conditions among US Medicare beneficiaries. Spine J 2012 Oct;12(10):902-11 PMID: 23098615

Pubmed ID

23098615

Abstract

BACKGROUND CONTEXT: Readmissions within 30 days of hospital discharge are undesirable and costly. Little is known about reasons for and predictors of readmissions after elective spine surgery to help plan preventative strategies.

PURPOSE: To examine readmissions within 30 days of hospital discharge, reasons for readmission, and predictors of readmission among patients undergoing elective cervical and lumbar spine surgery for degenerative conditions.

STUDY DESIGN: Retrospective cohort study.

PATIENT SAMPLE: Patient sample includes 343,068 Medicare beneficiaries who underwent cervical and lumbar spine surgery for degenerative conditions from 2003 to 2007.

OUTCOME MEASURES: Readmissions within 30 days of discharge, excluding readmissions for rehabilitation.

METHODS: Patients were identified in Medicare claims data using validated algorithms. Reasons for readmission were classified into clinically meaningful categories using a standardized coding system (Clinical Classification Software).

RESULTS: Thirty-day readmissions were 7.9% after cervical surgery and 7.3% after lumbar surgery. There was no dominant reason for readmissions. The most common reasons for readmissions were complications of surgery (26%-33%) and musculoskeletal conditions in the same area of the operation (15%). Significant predictors of readmission for both operations included older age, greater comorbidity, dual eligibility for Medicare/Medicaid, and greater number of fused levels. For cervical spine readmissions, additional risk factors were male sex, a diagnosis of myelopathy, and a posterior or combined anterior/posterior surgical approach; for lumbar spine readmissions, additional risk factors were black race, Middle Atlantic geographic region, fusion surgery, and an anterior surgical approach. Our model explained more than 60% of the variability in readmissions.

CONCLUSIONS: Among Medicare beneficiaries, 30-day readmissions after elective spine surgery for degenerative conditions represent a target for improvement. Both patient factors and operative techniques are associated with readmissions. Interventions to minimize readmissions should be specific to surgical site and focus on high-risk subgroups where clinical trials of interventions may be of greatest benefit.

Author List

Wang MC, Shivakoti M, Sparapani RA, Guo C, Laud PW, Nattinger AB

Authors

Purushottam W. Laud PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Ann B. Nattinger MD, MPH Associate Provost, Professor in the Medicine department at Medical College of Wisconsin
Rodney Sparapani PhD Assistant Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Marjorie Wang MD Chief, Professor in the Neurosurgery department at Medical College of Wisconsin




Scopus

2-s2.0-84870296222   72 Citations

MESH terms used to index this publication - Major topics in bold

Aged
Aged, 80 and over
Cervical Vertebrae
Elective Surgical Procedures
Female
Humans
Lumbar Vertebrae
Male
Medicare Part A
Middle Aged
Patient Readmission
Postoperative Complications
Risk Factors
Spinal Diseases
United States
jenkins-FCD Prod-296 4db9d02597e0a2e889e230f853b641c12f1c3ee3