General Session: Cervical-2
Presented by: A. Samuel - View Audio/Video Presentation (Members Only)
A. Samuel(1), J. Toy(1), M. Fu(2), A. Lukasiewicz(1), M. Webb(1), D. Bohl(3), B. Basques(3), T. Albert(2), J. Grauer(1)
(1) Yale University School of Medicine, New Haven, CT, United States
(2) Hospital for Special Surgery, New York City, NY, United States
(3) Rush University Medical Center, Chicago, IL, United States
Introduction: The anterior cervical discectomy and fusion (ACDF) is a relatively safe and effective surgical procedure. However, as hospital quality-based reimbursements begin to be tied to readmissions within the 30 days after discharge, understanding the reasons that patients are readmitted after surgery is important for both practitioners and administrators. Methods and materials: All patients undergoing ACDF were identified in the 2012 and 2013 American College of Surgeons National Surgical Quality Improvement Program (NSQIP). Reasons for readmission in the 30 days after surgery were assessed. Multivariate logistic regression was then used to identify risk factors for readmission.
Results: A total of 10,006 patients undergoing ACDF were identified in the 2012 and 2013 NSQIP. Of those patients, 3.32% (332 patients) were readmitted in the 30 days after surgery (Table 1). Of these readmitted patients, 159 (1.59% of total study population) were readmitted for non-surgical site related reasons (Table 1). The most common non-surgical site related reasons were cardiovascular reasons (n = 30), neuro/psychiatric reason (n = 21), other infections (n = 21), and pneumonia (n = 20). A total of 114 patients (1.14% of total study population), were readmitted for surgical-site related reasons. The most common surgical site related reasons were hematoma/hemorrhage (n = 25), surgical site infection (n = 23), and dysphagia (n = 21). In multivariate analysis, the only frisk factors found to be predictive of readmission within 30 days were older age (70 - 79 years, compared to 50 - 59 years; odds ratio [95% confidence interval]: 1.73 [1.23 - 2.42]) and higher American Society of Anesthesiologists (ASA) class (ASA III: 1.89 [1.48 - 2.41]; ASA IV+: 5.23 [3.23 - 8.41]). Factors that were not found to be predictive of readmission included inpatient versus outpatient surgery, number of levels fused, and nature of the index cervical spine pathology.
Conclusions: Readmissions are relatively uncommon after ACDF. However, as hospital reimbursements are tied to readmissions in the 30 days after discharge, it is important to understand which patients are being readmitted and for what reasons. Most readmissions after ACDF were due to non-surgical site related reasons, indicating the importance of careful patient selection, aggressive preoperative medical optimization, and adequate postoperative monitoring. The most common surgical site related reasons were, unsurprisingly, due to bleeding, infection, and dysphagia, each occurring in only around 0.25% of all patients. Factors such as inpatient versus outpatient surgery, number of levels fused, primary diagnosis were not found to play independent significant roles.