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Kanna RM, Shafeeq GM, Shetty AP, Rajasekaran S. The incidence and risk factors for unplanned readmission within 90 days after surgical treatment of spinal fractures. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024:10.1007/s00586-024-08420-5. [PMID: 39048842 DOI: 10.1007/s00586-024-08420-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 07/15/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024]
Abstract
INTRODUCTION Unplanned readmissions after spine surgery are undesired, and cause significant functional, and financial distress to the patients and healthcare system. Though critical, knowledge about readmissions after surgery for traumatic spinal injuries (TSI) is scarce and under-evaluated. METHODS Consecutive patients surgically treated for TSI and who had unplanned readmission within 90 days post-discharge were studied. Peri-operative demographic and surgical variables, surgical treatment, level of injury, delay in surgery, ASIA score, other organ injuries, peri-operative complications, smoking, ICU stay, co-morbidity, and the length of hospital stay were studied and correlated with the causes for readmission. RESULTS Among 884 patients, 4.98% (n = 44) had unplanned readmissions within 90 days of discharge. Notably, 50% (n = 22) patients were readmitted within the first 30 days. The common causes of readmissions were urinary tract related problems (27%, n = 12), pressure ulcers (20.4%, n = 9), respiratory problems (13.6%, n = 6), surgical wound related problems (14%, n = 7,) limb injuries (11.4%, n = 5), and others (11%, n = 5). The total beds lost secondary to readmissions was 314 days, and the mean bed-days lost per patient was 7.2 ± 5.1. Thirteen peri-operative risk factors were associated with unplanned readmissions, among which, smoking (OR 2.2), diabetes (OR 2.4), and pressure sore during index admission (OR 16.7) were strong independent predictors. CONCLUSION The incidence of unplanned readmissions after TSI was 5%, which was similar to elective spine surgeries but the causes and risk factors are different. Non-surgical complications related to urinary tract, respiratory care and pressure sores were the most common causes. Pre-operative smoking status, diabetes mellitus and pressure sores noted in the index admission were important independent risk factors.
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Affiliation(s)
- Rishi M Kanna
- Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India.
| | - Gulam Muhammed Shafeeq
- Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - Ajoy P Shetty
- Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - S Rajasekaran
- Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
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Mueller KB, Hou Y, Beach K, Griffin LP. Development and validation of a point-of-care clinical risk score to predict surgical site complication-associated readmissions following open spine surgery. JOURNAL OF SPINE SURGERY (HONG KONG) 2024; 10:40-54. [PMID: 38567014 PMCID: PMC10982919 DOI: 10.21037/jss-23-89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/21/2023] [Indexed: 04/04/2024]
Abstract
Background Surgical site complications (SSCs) contribute to increased healthcare costs. Predictive analytics can aid in identifying high-risk patients and implementing optimization strategies. This study aimed to develop and validate a risk-assessment score for SSC-associated readmissions (SSC-ARs) in patients undergoing open spine surgery. Methods The Premier Healthcare Database (PHD) of adult patients (n=157,664; 3,182 SSC-ARs) between January 2019 and September 2020 was used for retrospective data analysis to create an SSC risk score using mixed effects logistic regression modeling. Full and reduced models were developed using patient-, facility-, or procedure-related predictors. The full model used 37 predictors and the reduced used 19. Results The reduced model exhibited fair discriminatory capability (C-statistic =74.12%) and demonstrated better model fit [Pearson chi-square/degrees of freedom (DF) =0.93] compared to the full model (C-statistic =74.56%; Pearson chi-square/DF =0.92). The risk scoring system, based on the reduced model, comprised the following factors: female (1 point), blood disorder [2], congestive heart failure [2], dementia [3], chronic pulmonary disease [2], rheumatic disease [3], hypertension [2], obesity [2], severe comorbidity [2], nicotine dependence [1], liver disease [2], paraplegia and hemiplegia [3], peripheral vascular disease [2], renal disease [2], cancer [1], diabetes [2], revision surgery [2], operative hours ≥5 [4], emergency/urgent surgery [2]. A final risk score (sum of the points for each surgery; range, 0-40) was validated using a 1,000-surgery random hold-out sample (C-statistic =85.16%). Conclusions The resulting SSC-AR risk score, composed of readily obtainable clinical information, could serve as a robust predictive tool for unplanned readmissions related to wound complications in the preoperative setting of open spine surgery.
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Affiliation(s)
- Kyle B. Mueller
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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McCurdy M, Narayanan R, Tarawneh O, Lee Y, Sherman M, Ezeonu T, Carter M, Canseco JA, Hilibrand AS, Vaccaro AR, Kepler CK, Schroeder GD. In-hospital mortality trends after surgery for traumatic thoracolumbar injury: A national inpatient sample database study. BRAIN & SPINE 2024; 4:102777. [PMID: 38465282 PMCID: PMC10924174 DOI: 10.1016/j.bas.2024.102777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/13/2024] [Accepted: 02/22/2024] [Indexed: 03/12/2024]
Abstract
Introduction Given the increasing incidence of traumatic thoracolumbar injuries in recent years, studies have sought to investigate potential risk factors for outcomes in these patients. Research question The aim of this study was to investigate trends and risk factors for in-hospital mortality after fusion for traumatic thoracolumbar injury. Materials and methods Patients undergoing thoracolumbar fusion after traumatic injury were queried from the National Inpatient Sample (NIS) from 2012 to 2017. Analysis was performed to identify risk factors for inpatient mortality after surgery. Results Patients in 2017 were on average older (51.0 vs. 48.5, P = 0.004), had more admitting diagnoses (15.5 vs. 10.7, p < 0.001), were less likely to be White (75.8% vs. 81.2%, p = 0.006), were from a ZIP code with a higher median income quartile (Quartile 1: 31.4% vs. 28.6%, p = 0.011), and were more likely to have Medicare as a primary payer (22.9% vs. 30.1%, p < 0.001). Bivariate analysis of demographics and surgical characteristics demonstrated that patients in the in-hospital mortality group (n = 90) were older (70.2 vs. 49.6, p < 0.001), more likely to be male (74.4% vs. 62.8%, p = 0.031), had a great number of admitted diagnoses (21.3 vs. 12.7, p < 0.001), and were more likely to be insured by Medicare (70.0% vs. 27.0%, p < 0.001). Multivariate regression analysis found age (OR 1.06, p < 0.001) and Black race (OR 3.71, p = 0.007) were independently associated with in-hospital mortality. Conclusion Our study of nationwide, traumatic thoracolumbar fusion procedures from 2012 to 2017 in the NIS database found older, black patients were at increased risk for in-hospital mortality after surgery.
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Affiliation(s)
- Michael McCurdy
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Rajkishen Narayanan
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Omar Tarawneh
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Yunsoo Lee
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Matthew Sherman
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Teeto Ezeonu
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Michael Carter
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Alan S Hilibrand
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Ouyang H, Hu Y, Hu W, Zhang H, Sun Z, Tang Y, Jiang Y, Chen J, Dong S, Li W, Tian Y. Incidences, causes and risk factors of unplanned reoperations within 30 days of spine surgery: a single-center study based on 35,246 patients. Spine J 2022; 22:1811-1819. [PMID: 35878756 DOI: 10.1016/j.spinee.2022.07.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 07/17/2022] [Accepted: 07/18/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Unplanned reoperation, a quality indicator in spine surgery, has not been sufficiently investigated in a large-scale, single-center study. PURPOSE To assess the incidences, causes, and risk factors of unplanned reoperations within 30 days of spine surgeries in a single-center study. STUDY DESIGN Retrospective observational study. PATIENT SAMPLE A cohort of 35,246 patients who underwent spinal surgery in our hospital were included. OUTCOME MEASURES The rates, chief reasons, and risk factors for unplanned reoperations within 30 days of spine surgery. METHODS We retrospectively analyzed the data for patients who underwent spine surgeries for degenerative spinal disorders, tumor, or deformity and had subsequent unplanned operations within 30 days at a single tertiary academic hospital from January 2016 to July 2021. Univariate and multivariate analyses were performed to assess the incidences, causes, and risk factors. RESULTS Out of 35,246 spinal surgery patients, 297 (0.84%) required unplanned reoperations within 30 days of spine surgery. Patients with a thoracic degenerative disease (3.23%), spinal tumor (1.63%), and spinal deformity (1.50%) had significantly higher rates of reoperation than those with atlantoaxial (0.61%), cervical (0.65%), and lumbar (0.82%) degenerative disease. The common causes for reoperation included epidural hematoma (0.403%), wound infections (0.148%), neurological deficit (0.108%), and pedicle screw malposition (0.077%). Unplanned reoperations were classified as hyperacute (45.45%), acute (30.98%), subacute (15.82%), or chronic (7.74%). Univariate analysis indicated that 20 clinical factors were associated with unplanned reoperation (p<.05). Multivariate Poisson regression analysis revealed that anemia (p<.001), osteoporosis (p=.048), ankylosing spondylitis (p=.008), preoperative foot drop (p=.011), deep venous thrombosis (p<.001), and previous surgical history (p<.001) were independent risk factors for unplanned spinal reoperation. CONCLUSIONS The incidence of unplanned spinal reoperations was 0.84%. The chief common causes were epidural hematoma, wound infections, neurological deficit, and pedicle screw malposition. Anemia, osteoporosis, ankylosing spondylitis, preoperative foot drop, deep venous thrombosis, and previous surgical history led to an increased risk of unplanned reoperation within 30 days of spine surgery.
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Affiliation(s)
- Hanqiang Ouyang
- Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Road, Haidian District, Beijing 100191, China; Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Road, Haidian District, Beijing 100191, China
| | - Yuanyu Hu
- Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Road, Haidian District, Beijing 100191, China; Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Road, Haidian District, Beijing 100191, China
| | - Wenshuang Hu
- Department of Medical Affairs, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing 100191, China
| | - Hua Zhang
- Research Center of Clinical Epidemiology, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing 100191, China
| | - Zhuoran Sun
- Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Road, Haidian District, Beijing 100191, China; Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Road, Haidian District, Beijing 100191, China
| | - Yanchao Tang
- Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Road, Haidian District, Beijing 100191, China; Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Road, Haidian District, Beijing 100191, China
| | - Yu Jiang
- Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Road, Haidian District, Beijing 100191, China; Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Road, Haidian District, Beijing 100191, China
| | - Jianming Chen
- Department of Medical Record, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing 100191, China
| | - Shu Dong
- Department of Medical Affairs, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing 100191, China
| | - Weishi Li
- Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Road, Haidian District, Beijing 100191, China; Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Road, Haidian District, Beijing 100191, China.
| | - Yun Tian
- Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Road, Haidian District, Beijing 100191, China; Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Road, Haidian District, Beijing 100191, China.
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