title: Hospital-Acquired Conditions in Adult Spinal Deformity Surgery: Predictors for Hospital-Acquired Conditions and Other 30-Day Postoperative Outcomes.
abstract: METHODS
  A retrospective study of prospectively collected data.
  
  
  OBJECTIVE
  The aim of this study was to identify risk factors in developing hospital-acquired conditions (HACs) and association of HACs with other 30-day complications in the adult spinal deformity (ASD) population.
  
  
  BACKGROUND
  HACs are subject to a nonpayment policy by the Center for Medicare and Medicaid Services and provide an incentive for medical institutions to improve patient safety. HACs in the ASD population may further exacerbate the already high rates of postoperative morbidity and mortality.
  
  
  METHODS
  The 2010 to 2014 ACS-NSQIP database was queried using Current Procedural Terminology (CPT) codes for adults who had fusion for spinal deformity. Patients were divided into two cohorts on the basis of the development of an HAC, as defined as a case of surgical site infection, urinary tract infection, or venous thromboembolism. Univariate and multivariate logistic regression analyses were employed to determine predictors for HACs and association of HACs with other 30-day postoperative outcomes.
  
  
  RESULTS
  Five thousand eight hundred nineteen patients met the inclusion criteria for the study of whom 313 (5.4%) had an HAC. Multivariate logistic regression analysis revealed that age 61 to 70 versus ≤50 years [odds ratio (OR) = 1.58, 1.10-2.27, P = 0.013], 71 to 80 versus ≤50 years (OR = 1.94, 1.31-2.87, P = 0.001), and >80 versus ≤50 years (OR = 2.30, 1.21-4.37, P = 0.011), dependent/partially dependent versus independent functional status (OR = 1.74, 1.13-2.68, P = 0.011), combined versus anterior surgical approach (OR = 2.46, 1.43-4.24, P = 0.001), and posterior versus anterior surgical approach (OR = 1.64, 1.19-2.25, P = 0.002), osteotomies (OR = 1.61, 1.22-2.13, P = 0.001), steroid use (OR = 2.19, 1.39-3.45, P = 0.001), obesity (OR = 1.38, 1.09-1.74, P = 0.007), and operation time ≥4 hours (OR = 2.42, 1.82-3.21, P < 0.001) were predictive factors in developing an HAC.
  
  
  CONCLUSIONS
  Several modifiable and nonmodifiable factors (age, functional status, surgical approach, utilization of osteotomies, steroid use, obesity, and operation time ≥4 hours) were associated with developing an HAC. HACs were also risk factors for other postoperative complications.
  
  
  METHODS
  3.
authors: Department of Orthopaedics Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
authors: John
authors: J
authors: Di Capua
authors: Sulaiman
authors: S
authors: Somani
authors: Jun S
authors: JS
authors: Kim
authors: Dante M
authors: DM
authors: Leven
authors: Nathan J
authors: NJ
authors: Lee
authors: Parth
authors: P
authors: Kothari
authors: Samuel K
authors: SK
authors: Cho
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013121:Spinal Curvatures / Q000453:epidemiology / Q000601:surgery*; D013122:Spinal Diseases / Q000601:surgery; D013123:Spinal Fusion / Q000009:adverse effects* / Q000706:statistics & numerical data; D013130:Spinal Stenosis / Q000601:surgery; D013131:Spine / Q000601:surgery*; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000209:etiology; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000209:etiology