Predictors of unplanned readmission in patients undergoing lumbar decompression: multi-institutional analysis of 7016 patients.
OBJECTIVE
Unplanned hospital readmission represents a large financial burden on the Centers for Medicare and Medicaid Services, commercial insurance payers, hospitals, and individual patients, and is a principal target for cost reduction. A large-scale, multi-institutional study that evaluates risk factors for readmission has not been previously performed in patients undergoing lumbar decompression procedures. The goal of this multicenter retrospective study was to find preoperative, intraoperative, and postoperative predictive factors that result in unplanned readmission (UR) after lumbar decompression surgery.


METHODS
The National Surgical Quality Improvement Program (NSQIP) database was retrospectively reviewed to identify all patients who received lumbar decompression procedures in 2011. Risk-adjusted multivariate logistic regression analysis was performed to estimate independent predictors of UR.


RESULTS
The overall rate of UR among patients undergoing lumbar decompression was 4.4%. After multivariate logistic regression analysis, anemia (odds ratio [OR] 1.48), dependent functional status (OR 3.03), total operative duration (OR 1.003), and American Society of Anesthesiologists Physical Status Class 4 (OR 3.61) remained as independent predictors of UR. Postoperative complications that were significantly associated with UR included overall complications (OR 5.18), pulmonary embolism (OR 3.72), and unplanned reoperation (OR 56.91).


CONCLUSIONS
There were several risk factors for UR after lumbar spine decompression surgery. Identification of high-risk patients and appropriate allocation of resources to reduce postoperative incidence may reduce the readmission rate.
Rosalind Franklin University of Medicine and Science, Chicago Medical School, North Chicago; and.
Bobby D
BD
Kim
Timothy R
TR
Smith
Seokchun
S
Lim
George R
GR
Cybulski
John Y S
JY
Kim
D019299:Decompression, Surgical; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010359:Patient Readmission / Q000191:economics*; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology; D011237:Predictive Value of Tests; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
ASA = American Society of Anesthesiologists; BMI = body mass index; CHF = congestive heart failure; COPD = chronic obstructive pulmonary disease; CPT = Current Procedural Terminology; ICD-9-CM = International Classification of Diseases, Ninth Revision, Clinical Modification; NSQIP = National Surgical Quality Improvement Program; National Surgical Quality Improvement Program; OR = odds ratio; PCI = percutaneous coronary intervention; PPACA = Patient Protection and Accountable Care Act; RVU = relative value unit; SSI = surgical site infection; TIA = transient ischemic attack; UR = unplanned readmission; lumbar decompression; unplanned readmission