Unplanned 30-Day readmission rates after spine surgery in a community-based Hospital setting.

OBJECTIVE: Unplanned readmissions after spinal surgery adversely affect not only healthcare costs but also the quality of delivered care. The primary objective of this study was to identify the rates and predicting factors of unplanned 30-day readmissions at a community-based hospital. PATIENTS AND METHODS: This study is a retrospective review of a single-center community-based hospital administrative and clinical records identifying unplanned readmissions. Risk factors for readmissions due to surgical site infections, pain, medical vs. procedure-related complications, and the number of readmissions were studied using multiple logistic regression analysis. RESULTS: A total overall readmission rate was 7.3 % (79 readmissions for 1077 patients). The readmission rates for thoracolumbar and cervical surgeries were 5.5 % and 1.8 %, respectively. The mean duration to primary readmission was 11.4 + 8.5 days. The most common procedure-related complication diagnosed at readmittance was wound-related complications (26 readmissions, 32.9 %). The most common non-surgical complication was a drug reaction or overdose (10.1 %). Multivariate logistic regression analyses revealed that longer hospitalization was a highly significant predictor of wound-related complications, followed by discharge to home or home care, and lower ASA scores (all <0.048). A younger age predicted readmissions due to pain (p = 0.014) and longer OR time did not reach statistical significance (p = 0.079). Higher ASA scores predicted readmissions due to medical vs. surgical complications (p = 0.028). There were no statistically significant predictors identified for more than one readmission during the 30-day post-discharge period. CONCLUSIONS: The overall rate of 30-day unplanned readmissions at a community-based hospital was 7.3 % for patients undergoing spinal surgeries and was similar to the rates reported by larger academic tertiary care institutions and registry-based studies. The study suggests that surgical site infections was the most common reason for readmissions, which was predictive by longer hospitalization, discharge disposition, and lower ASA scores.

The impact of BMI on operating room time, blood loss, and hospital stay in patients undergoing spinal fusion.

OBJECTIVE: Obesity affects not only the health of an individual but society as a whole and especially the healthcare system. Healthcare providers are faced with challenges to deliver adequate care in this resource-limited environment, assure safety, and accommodate the increasing population of overweight patients. The effects of increased body mass index (BMI) on clinical outcomes, complications, health care resource utilization, effectiveness of minimally invasive approaches, and perioperative parameters in spine surgeries have all been previously studied, but the majority of these findings are conflicting rather than conclusive. The main objective of this study was to analyze the impact of BMI on perioperative outcomes in patients undergoing one- to two-level elective TLIF procedures for degenerative spine conditions and to identify the need to modify internal hospital operational planning, team organization, and patient flow processes to accommodate patients who are overweight. PATIENTS AND METHODS: A single-center retrospective case-review study was completed. The study included 172 consecutive patients who underwent elective one- or two-level transforaminal lumbar interbody fusions (TLIF). The patients were categorized as obese if they had BMI value that was equal to or greater than 30 kg/m2. Outcome measures included surgical and non-operative operating room (OR) time, length of stay (LOS), and estimated blood loss (EBL). Multiple regression analyses were performed to determine if BMI had an effect on perioperative parameters while controlling for independent variables. RESULTS: BMI did not have a statistically significant effect on surgical (p = 0.13) and non-operative OR time (p = 0.82). Obese patients remained hospitalized on average 0.45 ± 0.25 days longer (p = 0.037) and lost 71.8 ± 26.3 mL more blood (p = 0.007). CONCLUSIONS: Obesity is associated with longer hospitalization and more intraoperative blood loss, but may have no impact on surgical and non-operative OR times in patients undergoing one- and two-level TLIFs.

Medical complications and mortality in octogenarians undergoing elective spinal fusion surgeries.

BACKGROUND: The consequences of suffering postoperative complications in elderly undergoing spinal surgeries may be different compared to younger patients. The primary objective of this study was to identify the types and frequency of medical complications and mortality rates in patients 80 years of age or older undergoing elective spinal fusion surgeries for degenerative spinal disease. METHODS: A prospective observational study with a retrospective chart review was performed, which included all consecutive patients ≥80 years old undergoing elective spinal fusion surgeries from May 2012 to August 2015. We identified a total of 95 patients, of which 39 cervical and 56 lumbar surgeries were performed. There were 41 female and 54 male patients with the mean age of 82.8 years (range, 80-91). The perioperative complications were allocated into the following categories: infection, pulmonary, cardiac, gastrointestinal, hematologic, urologic, neurovascular, thromboembolic, and other. Baseline and postoperative clinical outcome scores were compared to evaluate efficacy. RESULTS: The mean follow-up time was 14.8 months (range, 5 days to 37 months) with an overall mortality rate of 8.4%. The 30-day, 90-day, and 1-year mortality rates were 2.1, 2.1, and 4.2%, respectively. There were 53.9 and 71.4% patients with complications in the cervical and lumbar patient groups, respectively. The presence of general comorbidities and the number of intervertebral levels predicted the occurrence of perioperative complications. Also, longer OR times were associated with a higher number of complications per patient and the occurrence of a UTI. Dysphagia was a significant predictor in developing pneumonia and atelectasis. CONCLUSIONS: The incidence of perioperative medical complications and mortality rates in octogenarians undergoing elective spinal surgeries are quite high. The benefits of having surgery must be weighed against the risks of not only surgical but also adverse medical events. An informed decision-making process should include discussion of potential postoperative morbidity specific to this patient population in order to guide patient's acceptance of higher risks and expectations postoperatively. It is also important to identify potential complications and adapt preventive measures in order to help minimize them in this patient population.