title: Risk Factors and Independent Predictors of 30-Day Readmission for Altered Mental Status After Elective Spine Surgery for Spine Deformity: A Single-Institutional Study of 1090 Patients.
abstract: BACKGROUND
  Altered mental status (AMS) has been associated with inferior surgical outcomes. The factors leading to AMS after spine surgery are unknown. The aim of this study is to determine the risk factors and independent predictors of 30-day readmission for AMS in patients with spine deformity after undergoing elective spine surgery.
  
  
  METHODS
  The medical records of 1090 adult (≥18 years old) patients with spine deformity undergoing elective spine surgery at a major academic institution from 2005 to 2015 were reviewed. We identified 18 patients (1.65%) who had AMS as the primary driver for 30-day readmission after surgery. Patient demographics, comorbidities, and intraoperative and postoperative complication rates were collected for each patient. The primary outcome investigated in this study was risk factors associated with 30-day readmission for AMS.
  
  
  RESULTS
  Patient demographics and comorbidities were similar between both groups, with the AMS cohort being significantly older than the no-AMS cohort (70.11 vs. 61.93; P = 0.003). There were no significant differences in intraoperative variables and complication rates within the cohorts. The AMS cohort had a significantly higher proportion of patients transferred to the intensive care unit (AMS, 61.11% vs. no-AMS, 19.76%; P = 0.0002) and rate of pulmonary embolism (AMS, 11.11 vs. no-AMS, 0.93; P = 0.02) after surgery. Other postoperative complication rates were similar between the cohorts. In a multivariate stepwise regression analysis, age (P = 0.013) and ICU transfer (P = 0.0002) were independent predictors of 30-day readmission for AMS.
  
  
  CONCLUSIONS
  Our study suggests that increasing age and intensice care unit transfer are independent predictors of 30-day readmission for AMS after spine surgery in patients with spine deformity.
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, 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: Gireesh B
authors.initials: GB
authors.lastname: Reddy
authors.affiliation: Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Sergesketter
authors.affiliation: Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Hunter
authors.initials: H
authors.lastname: Warwick
authors.affiliation: Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Terrell
authors.initials: T
authors.lastname: Jones
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, Dallas, Texas, USA.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Bagley
authors.affiliation: Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Isaac O
authors.initials: IO
authors.lastname: Karikari
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017558:Elective Surgical Procedures / Q000009:adverse effects* / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology; D008875:Middle Aged; D010359:Patient Readmission / Q000639:trends; D010360:Patient Transfer / Q000639:trends; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013122:Spinal Diseases / Q000453:epidemiology / Q000601:surgery*; D013997:Time Factors
keywords: 30-day readmission; Altered mental status; Spine; Surgery