Perioperative morbidity and readmission rate in all spine patients in the COVID era

ABSTRACT

Introduction: The coronavirus (COVID-19) pandemic has presented healthcare workers with one of the most significant global health crises to date. Prior studies have not identified an increase in complications or readmissions in COVID-19 negative patients undergoing emergency or essential surgery during the pandemic. Similar findings have been found in the urgent and elective surgery population. However, no study has shown the risks of all spine surgeries during this time period. Therefore, the purpose of this study is to measure the rates of complications and readmissions for all patients who underwent spine procedures (elective, urgent, and emergent) since the beginning of the COVID-19 pandemic compared to historical averages. Material and Methods: A retrospective review was performed on patients who underwent any spine procedure performed by one of our fellowship-trained spine surgeons at a single tertiary academic center from January 1st, 2019 to June 22nd, 2021. Patients were split into Pre-COVID or Post-COVID cohorts based on the timing of their surgery. March 23, 2020 was designated as the bifurcation based on the first issuance of a Stay at Home Order for COVID-19 in our city. Inpatient complications, 90-day readmission, and inpatient mortality were compared between the two cohorts. Secondary analysis included multiple logistic regression to determine independent predictors of inpatient complications, 90-day readmission, and inpatient mortality. Results: A total of 2,978 patients were included in the final analysis with 1,702 patients receiving designation as Pre-COVID and 1,276 as Post-COVID. The two groups differed with regards to lower Elixhauser scores (1.47 vs 1.65, p = 0.001), lower preoperative diagnoses of stenosis (57.8% vs 62.5%, p = 0.010) and radiculopathy (23.7% vs 31.2%, p < 0.001), fewer revision surgeries (16.8% vs 21.9%, p < 0.001), and fewer patients discharged home (84.5% vs 88.2%, p = 0.011) in the Pre-COVID cohort. The two cohorts had similar inpatient complications (36.6% vs 36.3%, p = 0.893) and inpatient mortality (0.1% vs 0.2%, p = 0.193). The Post-COVID cohort had fewer 90-day readmission (6.1% vs 3.9%, p = 0.008). On regression, being a Post-COVID patient was an independent predictor of decreased 90-day readmission (OR 0.63, p = 0.011). Similarly, surgery in the cervical region was associated with decreased readmission (ref lumbar, OR 0.28, p = 0.001). Elixhauser (OR 1.12, p = 0.032), fusion surgeries (ref decompression, OR 1.80, p = 0.027), and being discharged to an inpatient rehab facility (ref home, OR 1.87, p = 0.021) were all associated with increased 90-day readmissions. Age (OR 1.01, p = 0.036), female sex (OR 1.33, p = 0.001), Elixhauser (OR 1.11, p < 0.001), length of stay (OR1.24, p < 0.001), anterior approach (ref posterior, OR 2.33, p < 0.001), and combined approach (ref posterior, OR 1.52, p < 0.001) were independent predictors of increased inpatient complications. Conclusion: Since COVID-19, patients undergoing spine surgery have an increased number of medical comorbidities, but a similar rate of inpatient complications and mortality. Patients are also being readmitted less frequently during the COVID-19 pandemic.