title: Thirty-day readmission rate and risk factors for patients undergoing single level elective anterior lumbar interbody fusion (ALIF).
abstract: Anterior lumbar interbody fusion (ALIF) represents a common interbody fusion technique and is advantageous given reduced risk of damage to the paraspinal muscles, posterior ligaments, and neural elements. In this study, we identified the readmission rate, common causes, and risk factors associated with single level ALIF 30-day readmission. Patients who underwent elective single level ALIF surgery from 2011 to 2013 were identified in the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database. Segmental fusion, emergency, and trauma cases were excluded. A total of 2,042 patients were identified from the ACS-NSQIP database from 2011 to 2013. The proportion of patients readmitted was 5.19% (106/2,042) and approximately 59.81% (64/106) had a reportable cause. The top three causes were poor post-operative pain control (11%), deep (9%) and superficial (9%) surgical site infections. Risk factors associated with 30-day readmission included age (odds ratio (OR)=1.02, 95% confidence interval (CI): 1.00-1.03, p value=0.05), history of severe chronic obstructive pulmonary disease (COPD), (OR=2.11, 95% CI: 0.95-4.70, p value=0.08), post-operative pneumonia (OR=6.58, 95% CI: 2.36-18.30, p value<0.001), and presence of superficial surgical site infection (OR=11.68, 95% CI: 4.88-27.95, p value<0.001). Bleeding disorders, anemia, and perioperative blood loss was not associated with 30-day readmission. Limitations include retrospective level 3 data, and missing data. This study represents the first nation-wide descriptive evaluation of 30-day readmission causes and risk factors for patients undergoing an ALIF procedure.
authors.affiliation: Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, NMH/Arkes Family Pavilion Suite 2210, Chicago, IL 60611, USA.
authors.forename: Roxanna M
authors.initials: RM
authors.lastname: Garcia
authors.affiliation: Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, NMH/Arkes Family Pavilion Suite 2210, Chicago, IL 60611, USA.
authors.forename: Winward
authors.initials: W
authors.lastname: Choy
authors.affiliation: Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, NMH/Arkes Family Pavilion Suite 2210, Chicago, IL 60611, USA.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: DiDomenico
authors.affiliation: Rosalind Franklin University of Medicine and Science, Chicago Medical School, North Chicago, IL 60064, USA.
authors.forename: Nikki
authors.initials: N
authors.lastname: Barrington
authors.affiliation: Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, NMH/Arkes Family Pavilion Suite 2210, Chicago, IL 60611, USA.
authors.forename: Nader S
authors.initials: NS
authors.lastname: Dahdaleh
authors.affiliation: Department of Surgery, Vascular Surgery Division, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
authors.forename: Heron E
authors.initials: HE
authors.lastname: Rodriguez
authors.affiliation: Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA.
authors.forename: Sandi
authors.initials: S
authors.lastname: Lam
authors.affiliation: Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, NMH/Arkes Family Pavilion Suite 2210, Chicago, IL 60611, USA. Electronic address: zsmith1@nm.org.
authors.forename: Zachary A
authors.initials: ZA
authors.lastname: Smith
mesh_terms: D000368:Aged; D016208:Databases, Factual / Q000639:trends; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000639:trends*; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000639:trends*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D013123:Spinal Fusion / Q000009:adverse effects / Q000639:trends*; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors
keywords: ALIF; Anterior lumbar interbody fusion; Pain control; Pneumonia; Readmission; Surgical site infections