title: Drivers of 30-Day Readmission in Elderly Patients (>65 Years Old) After Spine Surgery: An Analysis of 500 Consecutive Spine Surgery Patients.
abstract: BACKGROUND
  Early readmission after spine surgery is being used as a proxy for quality of care. One-fifth of patients are rehospitalized within 30 days after spine surgery, and more than one-third within 90 days; however, there is a paucity of data about the cause of early readmissions in elderly patients after elective spine surgery.
  
  
  METHODS
  A total of 500 elderly patients (>65 years old) undergoing elective spine surgery at a major academic hospital were included in the study. We identified all unplanned readmissions within 30 days of discharge. Unplanned readmissions were defined to have occurred as a result of either a surgical or a nonsurgical complication. Patient records were reviewed to determine the cause of readmission and the length of hospital stay.
  
  
  RESULTS
  A total of 50 (10%) unplanned early readmissions were identified. The mean ± SD age was 72.54 ± 5.84 years. The mean ± SD number of days from discharge to readmission was 11.02 ± 7.25 days, and the average length of hospital stay for the readmissions was 7.7 days. The majority of patients that were readmitted presented to the emergency department from home (46%), whereas 38% were readmitted from a skilled nursing facility. The most common causes for readmission were infection or a concern for infection (42%) and pain (14%), with 32% of readmissions requiring a return to the operating room.
  
  
  CONCLUSIONS
  Our study suggests that in elderly patients undergoing elective spine surgery, infection or a concern for infection, pain, and altered mental status were the most common primary reasons for unplanned readmission.
authors.affiliation: Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA. Electronic address: owoicho.adogwa@gmail.com.
authors.forename: Owoicho
authors.initials: O
authors.lastname: Adogwa
authors.affiliation: Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Aladine A
authors.initials: AA
authors.lastname: Elsamadicy
authors.affiliation: Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Jing
authors.initials: J
authors.lastname: Han
authors.affiliation: Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Isaac O
authors.initials: IO
authors.lastname: Karikari
authors.affiliation: Department of Neurosurgery, Yale University, New Haven, Connecticut, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Cheng
authors.affiliation: Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Bagley
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D019299:Decompression, Surgical / Q000706:statistics & numerical data; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007796:Laminectomy; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D009657:North Carolina / Q000453:epidemiology; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D015995:Prevalence; D012307:Risk Factors; D013123:Spinal Fusion / Q000706:statistics & numerical data
keywords: 30-day readmission; Elderly; Infection; Spine; Surgery