title: Hospital Readmission Within 2 Years Following Adult Thoracolumbar Spinal Deformity Surgery: Prevalence, Predictors, and Effect on Patient-derived Outcome Measures.
abstract: METHODS
  A retrospective review of prospective multicenter database.
  
  
  OBJECTIVE
  The aim of this study was to identify factors influencing readmission, reoperation, and the impact on health-related quality of life outcomes (HRQoLs) in adult spinal deformity (ASD) surgery.
  
  
  BACKGROUND
  Many ASD patients experience complications requiring readmission. It is important to identify baseline/operative factors leading to rehospitalizations and reoperation, which may impact outcomes.
  
  
  METHODS
  
  
  
  METHODS
  ASD surgical patients (age >18 yrs, major coronal Cobb ≥20°, sagittal vertical axis ≥5 cm, pelvic tilt ≥25°, and/or thoracic kyphosis >60°) with complete baseline, 1-, and 2-year follow-up. Patients were grouped on the basis of readmission occurrence (yes/no) and type [medical (no reoperation) vs. surgical (revision surgery)]. Readmissions caused by infections requiring surgical treatment (e.g., deep infections) were considered reoperations. Univariate and multivariate analyses determined readmission and reoperation predictors. Repeated measures mixed models evaluated readmission impact on HRQoLs at 1 and 2 years.
  
  
  RESULTS
  Three hundred thirty-four patients were included: 76 (22.8%) readmissions, involving 65 (85.5% of 76) reoperations (surgical readmission) and 11 (14.5% of 76) medical readmissions. The most common surgical readmission indication (n = 65) was implant complications (36.9%; rod breakage n = 13); the most common medical readmission indication was infection (36.4%, n = 4), treated with antibiotics. Noninfectious medical readmission (n = 7) included pleural effusion, deep vein thrombosis (DVT), intraoperative blood loss, neurologic, and unspecified. Readmission predictors: increased number of major peri-operative complications [odds ratio (OR) 5.13, P = 0.014], infection presence (OR 25.02, P = 0.001), implant complications (OR 6.12, P < 0.001), and radiographic complications (DJK, proximal junctional kyphosis, pseudoarthrosis, sagittal/coronal imbalance) (OR 16.94, P < 0.001). HRQoL analysis revealed overall improvement of the full cohort (P < 0.01), though the 76 readmitted improved less overall and at each time point P < 0.001) except in 6-week MCS (P = 0.14).
  
  
  CONCLUSIONS
  Major peri-operative, implant, radiographic, and infection complications during index were associated with increased readmission odds. Implant complications most frequently caused surgical readmissions. Readmitted patients improved in outcome scores, although less compared with the nonreadmitted cohort, yet displayed reduced 6-week SF-36 Mental Component Summary.
  
  
  METHODS
  3.
authors.affiliation: Department of Orthopaedic Surgery, NYU Medical Center Hospital for Joint Diseases, New York, NY.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Passias
authors.affiliation: Department of Orthopaedic Surgery, University of California Davis, Sacramento, CA.
authors.forename: Eric O
authors.initials: EO
authors.lastname: Klineberg
authors.affiliation: Department of Orthopaedic Surgery, NYU Medical Center Hospital for Joint Diseases, New York, NY.
authors.forename: Cyrus M
authors.initials: CM
authors.lastname: Jalai
authors.affiliation: Department of Orthopaedic Surgery, NYU Medical Center Hospital for Joint Diseases, New York, NY.
authors.forename: Nancy
authors.initials: N
authors.lastname: Worley
authors.affiliation: Department of Orthopaedic Surgery, NYU Medical Center Hospital for Joint Diseases, New York, NY.
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Poorman
authors.affiliation: Department of Orthopaedic Surgery, Rocky Mountain Hospital for Children, Denver, CO.
authors.forename: Breton
authors.initials: B
authors.lastname: Line
authors.affiliation: Department of Orthopaedic Surgery, NYU Medical Center Hospital for Joint Diseases, New York, NY.
authors.forename: Cheongeun
authors.initials: C
authors.lastname: Oh
authors.affiliation: Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS.
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Burton
authors.affiliation: Department of Orthopaedics, Hospital for Special Surgery, New York, NY.
authors.forename: Han Jo
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University, Baltimore, MD.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: D Kojo
authors.initials: DK
authors.lastname: Hamilton
authors.affiliation: Department of Neurosurgery, University of California San Francisco, San Francisco, CA.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Ames
authors.affiliation: Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA.
authors.forename: Justin S
authors.initials: JS
authors.lastname: Smith
authors.affiliation: Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA.
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Shaffrey
authors.affiliation: Department of Orthopaedics, Hospital for Special Surgery, New York, NY.
authors.forename: Virginie
authors.initials: V
authors.lastname: Lafage
authors.affiliation: Department of Orthopaedic Surgery, Rocky Mountain Hospital for Children, Denver, CO.
authors.forename: Shay
authors.initials: S
authors.lastname: Bess
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007738:Kyphosis / Q000601:surgery*; D008141:Lordosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D011446:Prospective Studies; D011788:Quality of Life; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery*; D013131:Spine / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult