title: Risk Factors for 30-Day Unplanned Readmission and Major Perioperative Complications After Spine Fusion Surgery in Adults: A Review of the National Surgical Quality Improvement Program Database.
abstract: METHODS
  Retrospective review of a prospective cohort.
  
  
  OBJECTIVE
  The aim of the study was to determine the patient characteristics and surgical procedure factors related to increased rates of 30-day unplanned readmission and major perioperative complications after spinal fusion surgery, and the association between unplanned readmission and major complications.
  
  
  BACKGROUND
  Reducing unplanned readmissions can reduce the cost of healthcare. Payers are implementing penalties for 30-day readmissions after discharge. There is limited data regarding the current rates and risk factors for unplanned readmission and major complications related to spinal fusion surgery.
  
  
  METHODS
  Spine fusion patients were identified using the 2012 and 2013 American College of Surgeons National Surgical Quality Improvement Program Participant User File. Rates of readmissions within 30 days after spine fusion surgery were calculated using the person-years method. Cox proportional hazards models were used to assess the independent associations of spine surgical procedure types, diagnoses, patient profiles, and major perioperative complications with unplanned related readmissions. Independent risk factors for major complications were assessed by multivariable logistic regression.
  
  
  RESULTS
  Of the 18,602 identified patients, there was a 5.2% overall major perioperative complication rate. There was a rate of 4.4% per 30 person-days for unplanned readmissions related to index surgery. Independent risk factors for both readmissions and major perioperative complications included combined anterior and posterior surgery, diagnosis of solitary tumor, older age, and higher American Society of Anesthesiologists class. Patients with deep/organ surgical site infection carried higher risk of having unplanned readmission, followed by pulmonary embolism, acute renal failure, and stroke/cerebral vascular accident with neurological deficit.
  
  
  CONCLUSIONS
  This study provides benchmark rates of 30-day readmission based on diagnosis and procedure codes from a high-quality database for adult spinal fusion patients and showed increased rates of 30-day unplanned readmission and major perioperative complications for patients with specific risk factors. Targeted preoperative planning on modifiable risk factors with proportional reimbursement may promote higher-quality healthcare.
  
  
  METHODS
  3.
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.|National Yang-Ming University, Taipei, Taiwan.
authors.forename: Alvin W
authors.initials: AW
authors.lastname: Su
authors.affiliation: Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN.|Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN.
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Habermann
authors.affiliation: Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN.
authors.forename: Kristine M
authors.initials: KM
authors.lastname: Thomsen
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Todd A
authors.initials: TA
authors.lastname: Milbrandt
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Nassr
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
authors.forename: A Noelle
authors.initials: AN
authors.lastname: Larson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D011183:Postoperative Complications / Q000209:etiology; D058996:Quality Improvement; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012307:Risk Factors; D013123:Spinal Fusion / Q000009:adverse effects*; D055815:Young Adult