Readmission Rates, Reasons, and Risk Factors in Elderly Patients Treated With Lumbar Fusion for Degenerative Pathology.
METHODS
Retrospective database review.


OBJECTIVE
To determine readmission rates after 1 to 2 level, primary, elective lumbar spinal fusion surgery for degenerative pathology and elucidate risk factors that predict increased risk of 30-day readmission SUMMARY OF BACKGROUND DATA.: Early postoperative readmissions after spine surgery represent a significant source of increased cost and morbidity. As the elderly population represents a demographic with a growing need for spine surgery, readmissions within this population are of significant interest.


METHODS
Medicare data (2005-2012) from an insurance database was queried for patients who underwent primary 1 to 2 level posterolateral lumbar spine fusion surgeries for degenerative lumbar pathology. After applying specific exclusion criteria to select for elderly patients (65-84 yr) undergoing mostly elective procedures, 52,567 patients formed the final study population. Readmission rates for medical, surgical, and all reasons were calculated within 30 days, 90 days, and 1 year postoperatively. Risk factors for medical, surgical, and all 30-day readmissions were also determined.


RESULTS
Within 30 days, 90 days, and 1 year, 1510 (2.9%), 2776 (5.3%), and 6574 (12.5%) patients were readmitted, respectively. At 30 days, surgical diagnoses constituted 50.1% of all readmissions. Wound infection was the reason for readmission in 25.8% of all readmissions within 30 days. Diagnoses of chronic pulmonary disease (OR 1.41 95% CI 1.22-1.63), obesity (OR 2.20 95% CI 1.90-2.54), and positive smoking history (OR 1.33 95% CI 1.15-1.54) were associated with increased risk of surgical readmission.


CONCLUSIONS
Elderly patients undergoing lumbar spine fusion experience 30-day, 90-day, and 1-year readmission rates of 2.9, 5.3, and 12.5% for both medical and surgical reasons. Surgical site infection and wound complications are the most common surgery-related reasons for readmission. Medical diagnoses are more predominant during later readmissions, highlighting the comorbidity burden present in elderly patients.


METHODS
4.
Department of Orthopedic Surgery, Johns Hopkins Hospital, Baltimore, MD.
Varun
V
Puvanesarajah
Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA.
Ali
A
Nourbakhsh
Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA.
Hamid
H
Hassanzadeh
Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA.
Adam L
AL
Shimer
Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA.
Francis H
FH
Shen
Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA.
Anuj
A
Singla
D000368:Aged; D000369:Aged, 80 and over; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000473:pathology* / Q000601:surgery; D008161:Lumbosacral Region / Q000473:pathology* / Q000601:surgery; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods; D013530:Surgical Wound Infection / Q000209:etiology