Elsevier

World Neurosurgery

Volume 97, January 2017, Pages 518-522
World Neurosurgery

Original Article
Drivers of 30-Day Readmission in Elderly Patients (>65 Years Old) After Spine Surgery: An Analysis of 500 Consecutive Spine Surgery Patients

https://doi.org/10.1016/j.wneu.2016.07.032Get rights and content

Background

Early readmission after spine surgery is being used as a proxy for quality of care. One-fifth of patients are rehospitalized within 30 days after spine surgery, and more than one-third within 90 days; however, there is a paucity of data about the cause of early readmissions in elderly patients after elective spine surgery.

Methods

A total of 500 elderly patients (>65 years old) undergoing elective spine surgery at a major academic hospital were included in the study. We identified all unplanned readmissions within 30 days of discharge. Unplanned readmissions were defined to have occurred as a result of either a surgical or a nonsurgical complication. Patient records were reviewed to determine the cause of readmission and the length of hospital stay.

Results

A total of 50 (10%) unplanned early readmissions were identified. The mean ± SD age was 72.54 ± 5.84 years. The mean ± SD number of days from discharge to readmission was 11.02 ± 7.25 days, and the average length of hospital stay for the readmissions was 7.7 days. The majority of patients that were readmitted presented to the emergency department from home (46%), whereas 38% were readmitted from a skilled nursing facility. The most common causes for readmission were infection or a concern for infection (42%) and pain (14%), with 32% of readmissions requiring a return to the operating room.

Conclusion

Our study suggests that in elderly patients undergoing elective spine surgery, infection or a concern for infection, pain, and altered mental status were the most common primary reasons for unplanned readmission.

Introduction

National health care costs have surged over the last quarter century at a concerning rate, with unplanned readmissions accounting for a significant amount of total health care expenditure.1 Accordingly, reducing hospital readmission rates has captured the interest of policymakers because they believe that reducing readmission rates represents a unique opportunity to simultaneously improve care while lowering total health care expenditure.2 In fact, as part of the Affordable Care Act, the U.S. Congress directed the Centers for Medicare and Medicaid services to reward physicians with the lowest readmission rates and penalize hospitals with “worse than expected” 30-day readmission rates.2

In recent decades, the fastest growth in complex spine surgery occurred in elderly patients (≥65 years old). These patients often present with poor baseline functional reserve, as well as other coexisting chronic medical conditions that contribute to high 30-day hospital readmissions rates.2 Although 30-day readmission rates are being used as a proxy for quality, as well as a tool used to compare health care quality across institutions, little is known about the reasons for unplanned readmissions in elderly patients undergoing complex spine surgery. The aim of this retrospective study is to assess and identify the drivers of unplanned 30-day readmissions in elderly patients undergoing complex spine surgery.

Section snippets

Methods

A total of 500 consecutive elderly patients (>65 years old) undergoing elective spine surgery at Duke University Hospital from 2008 to 2010 were included in this study. Institutional review board approval was obtained before the initiation of the study. We identified 50 patients who had unplanned readmissions to a major academic medical center within 30 days of discharge. We reviewed the hospital chart of each readmission to determine the cause of readmission and the length of stay. Unplanned

Results

From 2008 to 2010, 50 (10%) of 500 elderly patients (>65 years old) who underwent an elective spinal surgery had an unplanned early readmission. The mean ± SD age was 72.54 ± 5.84 years (Table 1). The numbers of male and white patients were 15.9% and 28.78%, respectively (Table 1). The mean ± SD body mass index was 28.70 ± 8.0 (Table 1). The comorbidities of the readmitted patients included: diabetes (12.8%), coronary artery disease (2.0%), hyperlipidemia (66.0%), myocardial infarction

Discussion

In this retrospective cohort study of drivers of 30-day readmission in elderly patients undergoing elective spine surgery, we demonstrate that infection or a concern for infection, poorly controlled pain and altered mental status were the most common primary reasons for unplanned readmissions. Furthermore, we observed that the preponderance of unplanned readmissions was the result of nonsurgical complications and only a minority of readmitted patients required surgical management.

The

Conclusions

Our study suggests that in elderly patients undergoing elective spine surgery, infection or a concern for infection, pain, and altered mental status were the most common primary reasons for unplanned readmission. Furthermore, the preponderance of 30-day readmissions was due to medical conditions, with only a minority of patients requiring surgical intervention.

References (8)

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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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