Lightning Podiums: Cervical Degenerative - Room 802A

Presented by: O. Zaki

Author(s):

O. Zaki(1), N. Jain(1), S. Khan(1)

(1) Ohio State University Wexner Medical Center, Columbus, OH, United States

Abstract

Background: Anterior cervical discectomy and fusion (ACDF) and posterior cervical fusion (PCF) are commonly performed procedures to treat unrelieved symptoms of cervical degenerative pathology. As healthcare transitions to value based models, reducing readmissions after elective procedures will be important. Numerous studies have reported the 30- and 90-day readmission rates, causes, and risk factors for cervical fusion. However, most of these studies have been drawn from administrative databases utilizing International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes. Given the limitations and drawbacks of using such databases, the aim of our study was to conduct a single institution retrospective chart review to identify the 30- and 90-day readmission rates, causes, and risk-factors after ACDF and PCF.

Methods: A retrospective cohort analysis of patients undergoing cervical fusion for degenerative cervical pathology over 2-years (2013-14) was done. Patients aged 18-85 who underwent ACDF or PCF and had at least 90-day follow up were included. Patients who had combined anterior and posterior fusion were excluded. Additionally, patients operated for fracture, malignancy or infection were excluded. Comprehensive chart review was performed to record demographic and clinical patient profile. Hospital readmission within 30- and 90-days was identified, and the causes and management was recorded. Descriptive analysis of patient profile has been given. Binary logistic regression analysis was done to study risk factors for readmission. Demographics, comorbidities, procedure- and discharge related factors served as covariates in our analysis. ACDF and PCF was studied separately.

Results: The ACDF cohort included 389 patients with a mean age of 52.0± 10.9 years, and the PCF cohort included 160 patients with a mean age of 61.2± 13.0 years. The 30-day readmission rate was 5.1% (n=20), and 90-day rate was 7.7% (n=30) after ACDF. These rates were 11.2% (n=18) and 16.9% (n=27) after PCF. The top two causes for readmission after ACDF were pulmonary (22.9%), and cardiac complications (14.3%). Likewise, sepsis (19.4%) and surgical site infection (16.1%) were the most common causes after PCF. Adjusted analysis found increased odds of unplanned readmission in patients with heart failure (OR 11.16, 95% CI: 2.24-55.51, p=0.03), history of malignancy (OR 4.68, 95% CI: 1.43-15.30, p=0.01), history of deep vein thrombosis (DVT) or pulmonary embolism (PE) (OR 21.46, 95% CI:4.93-93.48, p< 0.001), and any intraoperative complication (OR: 9.73, 95% CI= 1.59-59.38, p=0.01). In the PCF cohort, increased odds of unplanned readmission were found in patients with a history of ischemic heart disease (OR 6.42, 95% CI: 1.91-21.57, p=0.003), increasing number of fusion levels (OR 1.29, 95% CI: 1.03-1.62, p=0.03), and longer length of stay (OR 1.08, 95% CI: 1.02-1.14, p=0.01).

Conclusion: The rates and causes of readmission after ACDF and PCF have been identified. Our results add to existing literature about the causes and risk factors for unplanned readmission after cervical fusion and will help educate patients and providers.