title: Incidence and Risk Factors for 30-Day Unplanned Readmissions After Elective Posterior Lumbar Fusion.
abstract: METHODS
  Retrospective study of prospectively collected data.
  
  
  OBJECTIVE
  To perform a multiinstitutional assessment on the incidence and risk factors for unplanned readmissions following elective posterior lumbar fusion (PLF) surgery.
  
  
  BACKGROUND
  Understanding what may drive rehospitalizations is a necessary step toward higher quality care. Identifying risk factors for unplanned readmission is especially important for elective PLF, which is a common procedure that is known to be associated with significant adverse events.
  
  
  METHODS
  Adult patients undergoing PLF were identified using current procedure terminology (CPT) from the American College of Surgeons National Surgical Quality Improvement Program. Both descriptive and comparative statistics were performed for patient characteristics, clinical factors, and postoperative complications. Subsequently, a step-wise multivariate logistic regression was employed.
  
  
  RESULTS
  Of the 2301 patients who met inclusion criteria for this study, 117 were unplanned readmissions (5.1%). These occurred at a mean of 15.9 days (range: 3-30 days) after surgery. The risk-adjusted analysis revealed that bleeding disorder (odds ratio, OR = 2.8, confidence intervals, CI = 1.0-7.6, P = 0.043), insulin dependent diabetes (OR = 2.5, CI = 1.4-4.4, P = 0.004), and total length of stay > 5 days (OR = 1.8, CI = 1.2-2.8, P = 0.009) were independent predictors for unplanned readmission. Significant postoperative complications included wound complications (OR = 27.6, CI = 13.9-54.8, P < 0.0001), pulmonary embolism and/or deep vein thrombosis/thrombophlebitis (OR = 11.9, CI = 5.0-28.5, P < 0.0001), sepsis (OR = 8.5, CI = 2.3-32.1, P = 0.002), and urinary tract infections (OR = 2.4, CI = 0.9-6.9, P = 0.094).
  
  
  CONCLUSIONS
  The unplanned readmission rate for patients undergoing PLF was low, but this study's findings of potentially modifiable risk factors suggest that substantial improvement with this quality metric is possible.
  
  
  METHODS
  N/A.
authors.affiliation: Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Nathan J
authors.initials: NJ
authors.lastname: Lee
authors.affiliation: Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Parth
authors.initials: P
authors.lastname: Kothari
authors.affiliation: NeuroSpine Surgery Research Group, University of New South Wales, Sydney, Australia.|Faculty of Medicine, University of New South Wales, Sydney, Australia.
authors.forename: Kevin
authors.initials: K
authors.lastname: Phan
authors.affiliation: Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: John I
authors.initials: JI
authors.lastname: Shin
authors.affiliation: Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Holt S
authors.initials: HS
authors.lastname: Cutler
authors.affiliation: Vanderbilt University, Nashville, TN.
authors.forename: Nikita
authors.initials: N
authors.lastname: Lakomkin
authors.affiliation: Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Dante M
authors.initials: DM
authors.lastname: Leven
authors.affiliation: Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Javier Z
authors.initials: JZ
authors.lastname: Guzman
authors.affiliation: Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Samuel K
authors.initials: SK
authors.lastname: Cho
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000209:etiology*; D011787:Quality of Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D013123:Spinal Fusion / Q000009:adverse effects*; D055815:Young Adult