Risk Factors Associated With 30-day Readmissions After Instrumented Spine Surgery in 14,939 Patients: 30-day readmissions after instrumented spine surgery.
Spine (Phila Pa 1976)
; 40(13): 1022-32, 2015 Jul 01.
Article
em En
| MEDLINE
| ID: mdl-25856262
ABSTRACT
STUDY DESIGN:
A retrospective review of instrumented spine registry from an integrated US healthcare system.OBJECTIVE:
Investigate the 30-day readmission rate and risk factors after instrumented spine surgery. SUMMARY OF BACKGROUND DATA Published readmission rates range from 2% to over 20%. We were interested in learning which patients were at greatest risk, when did readmissions occur, and why.METHOD:
30-day readmission rates were determined for 14,939 patients after an index spine procedure between 1/2009 and 3/2013. Data were analyzed with descriptive statistics, univariate, and multivariate logistic regression analysis.RESULT:
The average age of the cohort was 59 (SD = 13.4) and 52% were female. The 30-day readmission rate was 5.5% (821/14,939). The temporal pattern for readmission was 17% (140) at week 1, 48% (394) at week 2, 72% (591) at week 3, and 100% (821) at week 4. The leading causes were wound complications (infection, hematoma, dehiscence, seroma), sepsis, pain management, pneumonia, and pulmonary emboli/deep venous thrombosis. In a multivariate model, readmission risk factors were malignancy (OR 2.99, 95% CI 1.56, 5.73), operative time more than 400 minutes (OR 2.59, 95% CI 1.66, 4.02), operative time 300-399 minutes (OR 2.33, 95% CI 1.54-3.52), hospital stay 6-10 days (OR 2.03, 95% CI 1.31-3.14), hospital stay more than 10 days (OR 1.85, 95% CI 1.1, -3.08), surgical complications (OR 1.67, 95% CI 1.18, 2.36), operative time 200-299 (OR 1.52, 95% CI 1.04, 2.22), depression (OR 1.48, 95% CI 1.14, 1.93), rheumatoid arthritis (OR 1.45, 95% CI 1.05, 2.01), deficiency anemia (OR 1.30, 95% CI 1.05, 1.61), and hypothyroidism (OR 1.29, 95% CI 1.01, 1.64).CONCLUSION:
Surgical complications (dural tear, deep infections, superficial infections, epidural hematoma), malignancy, lengthy operative times, and lengthy initial hospitalizations are all risk factors for 30-day readmission. These findings should be considered during preoperative assessment and surgical planning. LEVEL OF EVIDENCE 3.
Texto completo:
1
Coleções:
01-internacional
Contexto em Saúde:
1_ASSA2030
Base de dados:
MEDLINE
Assunto principal:
Readmissão do Paciente
/
Coluna Vertebral
/
Procedimentos Ortopédicos
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Aspecto:
Equity_inequality
Limite:
Adolescent
/
Adult
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Aged
/
Aged80
/
Female
/
Humans
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Male
/
Middle aged
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Spine (Phila Pa 1976)
Ano de publicação:
2015
Tipo de documento:
Article