title: Outpatient continuity of care and 30-day readmission after spine surgery.
abstract: The value of continuity of care in preventing 30-day readmissions after surgical procedures remains an issue of debate.
  
  
  
  This study aimed to investigate the association of being evaluated in the emergency room (ER) of the hospital where the original procedure was performed with 30-day readmissions for spine surgery patients.
  
  
  
  This is a cohort study.
  
  
  
  A total of 16,483 spine surgery patients were evaluated in the emergency department within 30-days postoperatively.
  
  
  
  A 30-day post-discharge readmission was the outcome measure.
  
  
  
  We performed a cohort study involving patients who were evaluated in the ER within 30-days after discharge following spine surgery from 2009 to 2013, and were registered in the Statewide Planning and Research Cooperative System database. A propensity score adjusted model was used to control for confounding.
  
  
  
  From our patients, 11,638 (70.6%) were seen in a hospital different from the one where the original procedure was performed (12.0% readmitted), and 4,845 (29.4%) were evaluated at the original hospital (10.9% readmitted). In a multivariable analysis, we demonstrated that being evaluated in the original hospital was associated with decreased rate of 30-day readmission (odds ratio [OR], 0.87; 95% confidence interval [CI], 0.77-0.97). We found similar associations in a propensity score adjusted model (OR, 0.87; 95% CI, 0.78-0.97). This corresponded to seven patients who needed to be evaluated in the hospital where the original procedure was performed to prevent one readmission.
  
  
  
  Using a comprehensive all-payer cohort of patients in New York State, who were evaluated in the ER after spine surgery, we identified an association of assessment in the hospital where the original procedure was performed with lower rate of 30-day readmissions. This underscores the potential importance of continuity of care in readmission prevention for these patients.
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
authors.forename: Symeon
authors.initials: S
authors.lastname: Missios
authors.affiliation: Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, One Medical Center drive, Lebanon, NH, USA; The Dartmouth Institute for Health Policy and Clinical Practice, One Medical Center drive, Lebanon, NH, USA. Electronic address: kbekelis@gmail.com.
authors.forename: Kimon
authors.initials: K
authors.lastname: Bekelis
mesh_terms: D000328:Adult; D000368:Aged; D003266:Continuity of Patient Care / Q000592:standards / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000706:statistics & numerical data; D010045:Outpatients / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology*; D013124:Spinal Injuries / Q000175:diagnosis / Q000601:surgery*
keywords: Continuity of care; Outpatient evaluation; Readmissions; SPARCS; Spine surgery