Predictors of 30-Day Hospital Readmission After Posterior Cervical Fusion in 3401 Patients

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Abstract

Study Design.

Retrospective cohort study.

Objective.

The aim of the study was to determine readmission rates and predictors of readmission after posterior cervical fusion (PCF).

Summary of Background Data.

PCFs are common spinal operations for a variety of spinal disorders including cervical myelopathy, unstable fractures, cervical deformity, and tumors. Data elaborating on risk factors for 30-day readmission are limited.

Methods.

Data were collected from the 2006 to 2013 American College of Surgeons National Surgical Quality Improvement Program database. Predictors of 30-day readmission comprising patient demographics, comorbidities, operative features, and postoperative complications were identified through logistic multivariable regression.

Results.

A total of 3401 patients met study criteria. Rate of 30-day readmission was 6.20%. Multilevel fusion was performed in 69.16% of patients. Postoperative infection was the most reason, accounting for 17.06% of all readmissions. Age older than 70 years (odds ratio [OR] = 1.61, P = 0.012), renal failure requiring dialysis (OR = 3.69, P = 0.011), anemia (OR = 1.57, P = 0.006), multilevel fusion (OR = 1.61, P = 0.012), surgical site infections (OR = 20.4, P < 0.001), wound dehiscence (OR = 19.08, P < 0.001), postoperative pneumonia (OR = 2.75, P = 0.01), pulmonary embolism (OR = 15.39, P < 0.001), and progressing renal insufficiency (OR = 10.13, P = 0.061) were significant predictors of hospital readmission.

Conclusion.

The identified predictors of readmission after PCF can improve patient counseling, identification of high-risk patients, and guide changes in healthcare delivery pathways. Patients with modifiable risk factors such as anemia and kidney failure may benefit from preoperative optimization. In addition, postoperative complications represent a key target for intervention.

Conclusion.

Level of Evidence: 3

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