A study published in the Journal of Neurosurgery: Spine examines factors associated with unplanned hospital readmissions, which represent a large financial burden for the Centers for Medicare and Medicaid Services.
The study examines patients undergoing lumbar decompressions using the National Surgical Quality Improvement Program database from 2011. Here are five key findings from the study:
1. Overall unplanned readmissions were 4.4 percent for the lumbar decompression patients. Another study published in the April 2014 edition of Spine examined 30-day unplanned readmission after lumbar spine surgery, finding the rate at 2.2 percent for patients undergoing discectomy. Around 38 percent were wound-related readmissions; 22.4 percent were pain-related; 92. percent were thromboembolic; and 8 percent were infection related.
2. The factors associated with unplanned readmissions were:
• Anemia
• Dependent functional status
• Total operative duration
• American Society of Anesthesiologists Physical Status Class 4
"There were several risk factors for UR after lumbar spine decompression surgery. Identification of high risk patients and appropriate allocation of resources to reduce postoperative incidence may reduce the readmission rate," concluded the study authors.
3. Postoperative complications significantly associated with unplanned readmissions were pulmonary embolism and unplanned reoperation. The predictors for readmission for patients undergoing lumbar spine surgery, according to the study published in Spine, were:
• Older age, particularly patients older than 80
• African American race
• Recent weight loss
• Chronic obstructive pulmonary disorder
• History of cancer
• Creatinine more than 1.2
• Elevated ASA class
• More than four hour operative time
• Prolonged hospital length of stay — more than four days
• More invasive procedures
4. Medscape published a study in 2013 showing patients undergoing fusion had a slightly higher one-year readmission rate than patients undergoing decompressions alone. The report also mentions there were nearly 38,000 lumbar spinal stenosis operations performed in 2008 at a cost of $1.7 billion, which was more than double the data from 1992.
5. However, another study published in the Journal of Neurosurgery: Spine conducted by Beejal Y. Amin, MD, from the University of California, San Francisco, found that spine surgery readmission rates may be overestimated since some patients with unrelated readmissions are still counted within the data. The report examined 5,780 patient encounters from 2007 to 2010, finding a 4.9 percent readmission rate.
There were 16 readmissions unrelated to spine surgery and 14 surgical cases that were cancelled or rescheduled at index admission. After excluding those cases, readmission costs were reduced 29 percent.
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