Rates and risk factors associated with 90-day readmission following cervical spine fusion surgery: analysis of the Michigan Spine Surgery Improvement Collaborative (MSSIC) registry.

BACKGROUND CONTEXT: Hospital readmission rates are an increasingly important focus. Identifying patients at risk for readmission can help decrease those rates and thus decrease the overall cost of care. PURPOSE: We sought to report the rates and the risk factors associated with 90-day hospital readmission after degenerative cervical spine surgery via either an anterior or posterior approach. STUDY DESIGN: Retrospective review of prospectively collected database PATIENT SAMPLE: Michigan Spine Surgery Improvement Collaborative (MSSIC) registry OUTCOME MEASURES: Hospital readmission at 90 days METHODS: The MSSIC registry prospectively enrolls patients undergoing surgery for degenerative cervical spine disease. The registry was queried over a 4-year period to determine patient characteristics and risk factors associated with unplanned readmission at 90 days following degenerative cervical spine fusion surgery through either an anterior or posterior approach. Univariate and multivariate regression modeling was used to compare patient characteristics and odds of readmission. RESULTS: Of 3,762 patients who underwent an anterior approach, 202 (5.4%) were readmitted within 90 days. Of 693 patients who underwent a posterior approach, 85 (12.3%) were readmitted within 90 days. Risk factors associated with increased likelihood of readmission after the anterior approach were male sex (odds ratio [OR] 1.56, confidence interval [CI] 1.10-2.20), American Society of Anesthesiologists class >2 (OR 1.70, CI 1.26-2.30), and increased length of stay (OR 1.10, CI 1.03-1.19). Factors associated with decreased likelihood of readmission after the anterior approach were being independently ambulatory preoperatively (OR 0.59, CI 0.46-0.76) and holding private insurance (OR 0.67, CI 0.50-0.90). A history of previous spine surgery was associated with increased risk of readmission after the posterior approach (OR 1.76, CI 1.37-2.25). Pain was the most common single reason cited for readmission after either approach (9% anterior, 13% posterior). After an anterior approach, common surgical reasons for readmission include new radicular findings (8%), dysphagia (6%), and surgical site hematoma (5%), whereas common medical reasons include pneumonia (7%), infection outside the surgical site (6%), and an electrolyte issue. After a posterior approach, common surgical reasons for readmission after 90 days include surgical site infection (8%) and new radicular findings (6%), whereas common medical reasons include infection outside the surgical site (9%), urinary tract infection (8%), and an abdominal issue (8%). CONCLUSIONS: Analysis of a large multicentered, spine-specific database for elective cervical spine fusion surgery demonstrated an unplanned 90-day readmission rate of 5.4% for the anterior approach and 12.3% for the posterior approach. Factors associated with readmission for the anterior approach include male sex, American Society of Anesthesiologists class >2, increased length of stay, holding private insurance, and being ambulatory preoperatively. A history of previous spine surgery was associated with increased odds of readmission after the posterior approach.

Prospective and Multicenter Evaluation of Outcomes for Quality of Life and Activities of Daily Living for Balloon Kyphoplasty in the Treatment of Vertebral Compression Fractures: The EVOLVE Trial.

BACKGROUND: Osteoporotic and neoplastic vertebral compression fractures (VCF) are common and painful, threatening quality of life and increasing risk of morbidity and mortality. Balloon kyphoplasty is a percutaneous option for treating painful cancer- and osteoporosis-related VCFs, supported by 2 randomized trials demonstrating efficacy benefits of BKP over nonsurgical care. OBJECTIVE: To investigate 12-mo disability, quality of life, and safety outcomes specifically in a Medicare-eligible population, representing characteristic patients seen in routine clinical practice. METHODS: A total of 354 patients with painful VCFs were enrolled at 24 US sites with 350 undergoing kyphoplasty. Four coprimary endpoints-Numerical Rating Scale (NRS) back pain, Oswestry Disability Index (ODI), Short Form-36 Questionnaire Physical Component Summary (SF-36v2 PCS), EuroQol-5-Domain (EQ-5D)-were evaluated for statistically significant improvement 3 mo after kyphoplasty. Data were collected at baseline, 7 d, and 1, 3, 6, and 12 mo (www.clinicaltrials.gov registration NCT01871519). RESULTS: At the 3-mo primary endpoint, NRS improved from 8.7 to 2.7 and ODI improved from 63.4 to 27.1; SF-36 PCS was 24.2 at baseline improving to 36.6, and EQ-5D improved from 0.383 to 0.746 (P < .001 for each). These outcomes were statistically significant at every follow-up time point. Five device-/procedure-related adverse events, intraoperative asymptomatic balloon rupture, rib pain, and aspiration pneumonia, and a new VCF 25 d postprocedure, and myocardial infarction 105 d postprocedure were reported and each resolved with proper treatment. CONCLUSION: This large, prospective, clinical study demonstrates that kyphoplasty is a safe, effective, and durable procedure for treating patients with painful VCF due to osteoporosis or cancer.