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Predictors of Thirty-Day Readmission After Anterior Cervical Fusion

Lovecchio, Francis BA*; Hsu, Wellington K. MD; Smith, Timothy R. MPH, MD, PhD; Cybulski, George MD, MBA; Kim, Bobby BS§; Kim, John Y. S. MD

doi: 10.1097/BRS.0000000000000051
Cervical Spine

Study Design. Retrospective cohort study.

Objective. To determine the incidence of and factors predicting 30-day readmission after anterior cervical discectomy and fusion (ACDF).

Summary of Background Data. ACDF is being performed on an increasing basis on a wider population of patients, which is accompanied by rising costs. Readmissions have the potential to further deplete health care resources. Although past studies have shown that readmissions after surgery are driven by operative complications, specific predictors of readmission after ACDF are not well researched.

Methods. All patients who underwent ACDF or anterior corpectomy and fusion procedures in 2011 were selected from the American College of Surgeon's National Quality Improvement database. Readmissions were analyzed on the basis of demographics, comorbidities, operative characteristics, and complications were compared in univariate analyses. Multivariate logistic regression models were created to isolate the independent effects of preoperative and postoperative factors on readmission.

Results. The nationwide readmission rate after ACDF surgery in this study is 2.5%. Pulmonary complications (8.5%), wound complications (8.5%), and urinary tract infections (8.5%) are the most common complications seen in readmitted patients. Readmitted patients were significantly older (58 vs. 53, P = 0.003), with higher rates of diabetes and hypertension (28.8% vs. 13.9%, P = 0.001; 64.4% vs. 42.6%, P = 0.001, respectively). Although certain preoperative factors such as age 65 years or more and preoperative stay more than 24 hours increase the odds of operative complications (odds ratio, 3.5; 95% confidence interval, 2.0–6.0 and odds ratio, 6.2; 95% confidence interval, 3.4–11.1, respectively), hypertension may independently increase the likelihood of readmission outside of any effect on complications (odds ratio, 1.8; 95% confidence interval, 1.0–3.4).

Conclusion. The data in this study suggests that surgeons are already controlling readmission rates by limiting peri- and postoperative complications, but patients with a history of hypertension could have an increased likelihood of being readmitted despite avoiding a complication.

Level of Evidence: 3

Nationwide retrospective cohort study assessing the incidence of and factors predicting 30-day readmission after anterior cervical fusion. Surgeons already limit readmissions by controlling operative complications, but hypertension may play an independent role in increasing readmission.

*Northwestern University Feinberg School of Medicine, Chicago, IL

Department of Orthopaedic Surgery and

Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL

§Rosalind Franklin University of Medicine and Science, North Chicago, IL; and

Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.

Address correspondence and reprint requests to John Y.S. Kim, MD, Department of Surgery, Northwestern University, Feinberg School of Medicine, 675 North St. Clair St, Galter Ste 19-250, Chicago, IL 60611; E-mail:

Acknowledgment date: June 20, 2013. First revision date: September 16, 2013. Acceptance date: September 21, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership and consultancy.

© 2014 by Lippincott Williams & Wilkins