RESUMEN
BACKGROUND: Unplanned 30-day readmissions after surgery are a source of patient dissatisfaction, monitored by the Centers for Medicare and Medicaid Services, have financial penalties for hospitals, and are publicly reported. Neurosurgical operations have a higher 30-day unplanned readmission rate after the index discharge than other specialties. After a simple initiative for a 48-72-hour postdischarge telephone call, there was an observed significant decrease in readmission rates from 17% to 8% in 7 months at Thomas Jefferson University. To better understand the role of postoperative telephone calls in this reduction, a retrospective evaluation over a longer period was performed. METHODS: A quality improvement initiative was assessed using patient records between August 2018 and May 2023. The primary observed subject is the 30-day unplanned readmission rate and secondarily a change in Physician Communication Score. Thirty-day unplanned readmission rate and Physician Communication Scores before and after the telephone call initiative were compared, checking for difference, variance, and correlation. RESULTS: 874 readmissions (average, 28/month; 95% confidence interval [CI], 25.3-29.3), 12.9% (95% CI, 11.9-13.9) were reported before the telephone call; of 673 readmissions (average, 26/month; 95% CI, 23-28.8), 12.9% (95% CI, 11.6-14.1) were reported after the telephone call. No significant difference, variance of scores or rates, or correlation of rate with communication score were noted before and after the initiative. CONCLUSIONS: Telephone calls and peridischarge efficient communication are needed after neurologic surgery. This approach decreased unplanned readmissions in certain instances without having a significant impact on neurosurgical patients.
RESUMEN
STUDY DESIGN: Retrospective Cohort Study. OBJECTIVES: To determine if decreased preoperative symptom duration is associated with greater clinical improvement in function and myelopathic symptoms after posterior cervical decompression and fusion (PCDF). METHODS: All patients over age 18 who underwent primary PCDF for cervical myelopathy or myeloradiculopathy at a single institution between 2014 and 2020 were retrospectively identified. Patient demographics, surgical characteristics, duration of symptoms, and preoperative and postoperative patient reported outcomes measures (PROMs) including modified Japanese Orthopaedic Association (mJOA), Neck Disability Index (NDI), Visual Analogue Scale (VAS) Neck, VAS Arm, and SF-12 were collected. Univariate and multivariate analyses were performed to compare change in PROMs and minimum clinically important difference achievement (%MCID) between symptom duration groups (< 6 months, 6 months-2 years, > 2 years). RESULTS: Preoperative symptom duration groups differed significantly by sex and smoking status. Patients with < 6 months of preoperative symptoms improved significantly in all PROMs. Patients with 6 months-2 years of preoperative symptoms did not improve significantly in mJOA, Physical Component Scores (PCS), or NDI. Patients with > 2 years of symptoms failed to demonstrate significant improvement in mJOA, NDI, or Mental Component Scores (MCS). Univariate analysis demonstrated significantly decreased improvement in mJOA with longer symptom durations. Increased preoperative symptom duration trended toward decreased %MCID for mJOA and MCS. Regression analysis demonstrated that preoperative symptom duration of > 2 years relative to < 6 months predicted decreased improvement in mJOA and NDI and decreased MCID achievement for mJOA and MCS. CONCLUSION: Increased duration of preoperative symptoms (> 2 years) before undergoing PCDF was associated with decreased postoperative improvement in myelopathic symptoms.
RESUMEN
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The aim was to investigate the clinical relevance of preoperative caudal adjacent segment degeneration (ASD) in patients undergoing isolated L4-5 fusion to determine a threshold of degeneration at which a primary L4-S1 fusion would be warranted. SUMMARY OF BACKGROUND DATA: Increased motion and biomechanical forces across the adjacent caudal segment in isolated L4-L5 fusion leads to concerns regarding the increased incidence of revision surgery because of the development of ASD. METHODS: Patients who underwent isolated L4-L5 fusion between 2014 and 2019 were reviewed. Pfirrmann grading and the disc heights of the caudal level relative to the rostral level were used to quantify preoperative adjacent degenerative disc disease. To assess the influence of preoperative caudal degenerative disc disease, preoperative disc height ratios (DHRs) were compared for patients who reported minimal, moderate, and severe Oswestry disability index (ODI) sores on postoperative assessment. For each patient-reported outcome measure (PROM), adjacent DDD was compared for those who did and did not meet MCID. An area under curve analysis was used to identify a threshold of degeneration impacting outcomes from the preoperative DHR. RESULTS: A total of 123 patients were studied with an average follow-up of 2.11 years. All patients demonstrated a significant improvement in all PROMs after surgery. When categorizing patients based on the severity of postoperative ODI scores, there were no preoperative differences in the L5-S1 Pfirrmann grading or DHRs. There was a significant association between greater preoperative anterior DHR and an increased number patients who met MCID for visual analog scale back. There were no radiographic differences in preoperative L5-S1 Pfirrmann grade or DHR for ODI, visual analog scale leg, MCS-12, or PCS-12. area under curve analysis was not able to identify a preoperative DHR threshold that reflected worse MCID for any PROM. CONCLUSION: No preoperative radiographic indicators of caudal ASD were predictive of worse clinical outcomes after isolated L4-5 fusion. LEVEL OF EVIDENCE: Level III.
