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. 2016 Dec 15;41(24):1933-1938.
doi: 10.1097/BRS.0000000000001631.

Readmission Rates, Reasons, and Risk Factors in Elderly Patients Treated With Lumbar Fusion for Degenerative Pathology

Varun Puvanesarajah  1 , Ali Nourbakhsh  2 , Hamid Hassanzadeh  2 , Adam L Shimer  2 , Francis H Shen  2 , Anuj Singla  2
Affiliations

Readmission Rates, Reasons, and Risk Factors in Elderly Patients Treated With Lumbar Fusion for Degenerative Pathology

Varun Puvanesarajah et al. Spine (Phila Pa 1976). .

Abstract

Study design: Retrospective database review.

Objective: To determine readmission rates after 1 to 2 level, primary, elective lumbar spinal fusion surgery for degenerative pathology and elucidate risk factors that predict increased risk of 30-day readmission SUMMARY OF BACKGROUND DATA.: Early postoperative readmissions after spine surgery represent a significant source of increased cost and morbidity. As the elderly population represents a demographic with a growing need for spine surgery, readmissions within this population are of significant interest.

Methods: Medicare data (2005-2012) from an insurance database was queried for patients who underwent primary 1 to 2 level posterolateral lumbar spine fusion surgeries for degenerative lumbar pathology. After applying specific exclusion criteria to select for elderly patients (65-84 yr) undergoing mostly elective procedures, 52,567 patients formed the final study population. Readmission rates for medical, surgical, and all reasons were calculated within 30 days, 90 days, and 1 year postoperatively. Risk factors for medical, surgical, and all 30-day readmissions were also determined.

Results: Within 30 days, 90 days, and 1 year, 1510 (2.9%), 2776 (5.3%), and 6574 (12.5%) patients were readmitted, respectively. At 30 days, surgical diagnoses constituted 50.1% of all readmissions. Wound infection was the reason for readmission in 25.8% of all readmissions within 30 days. Diagnoses of chronic pulmonary disease (OR 1.41 95% CI 1.22-1.63), obesity (OR 2.20 95% CI 1.90-2.54), and positive smoking history (OR 1.33 95% CI 1.15-1.54) were associated with increased risk of surgical readmission.

Conclusion: Elderly patients undergoing lumbar spine fusion experience 30-day, 90-day, and 1-year readmission rates of 2.9, 5.3, and 12.5% for both medical and surgical reasons. Surgical site infection and wound complications are the most common surgery-related reasons for readmission. Medical diagnoses are more predominant during later readmissions, highlighting the comorbidity burden present in elderly patients.

Level of evidence: 4.

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