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Hospital Readmission Rates After Surgical Treatment of Primary and Metastatic Tumors of the Spine

Schairer, William W., MD*; Carrer, Alexandra, MD*; Sing, David C., MD*; Chou, Dean, MD; Mummaneni, Praveen V., MD; Hu, Serena S., MD*; Berven, Sigurd H., MD*; Burch, Shane, MD*; Tay, Bobby, MD*; Deviren, Vedat, MD*; Ames, Christopher, MD

doi: 10.1097/BRS.0000000000000517
Health Services Research
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Study Design. Retrospective cohort study.

Objective. This study aimed to identify the rates and causes of unplanned hospital readmission at 30 days and 1 year after surgical treatment of primary and metastatic spinal tumors.

Summary of Background Data. Primary spine tumors and non–spine tumors metastatic to the spine can represent complex problems for surgical treatment, but surgical intervention can provide significant patients with significant improvements in quality of life. However, recent emphasis on decreasing the cost of health care has led to a focus on quality measures such as hospital readmission rates.

Methods. At a large referral spine center between 2005 and 2011, 197 patients with primary (n = 33) or metastatic (n = 164) tumors of the spine were enrolled. Hospital readmissions within 1 year were reviewed. Kaplan-Meier analysis was performed to estimate unplanned hospital readmission rates, and risk factors were evaluated using a Cox proportional hazards model.

Results. Unplanned hospital readmission rates were 6.1% and 16.8% at 30 days for primary and metastatic tumors (P = 0.126), respectively, and 27.5% and 37.8% at 1 year (P = 0.262). Metastatic tumors with aggressive biology (i.e., lung, osteosarcoma, stomach, bladder, esophagus, pancreas) caused higher rates of readmission than other types of metastatic tumors. One-third of readmissions were due to recurrent disease, whereas 23.3% were due to surgical complications and 43.3% due to medical complications. Numerous medical comorbidities increased the risk of unplanned hospital readmission.

Conclusion. Unplanned hospital readmissions after surgical intervention for spine tumors are common, and patients with aggressive metastatic tumors are at increased risk. In addition, comorbid medical problems are important risk factors that increase the chance that a patient will require hospital readmission within 1 year.

Level of Evidence: 3

Primary and metastatic spine tumors may have significant improvement in quality of life with surgical intervention. Quality measures such as readmission rate are used to assess quality of care, but baseline rates have not been established. This study details rates and causes of hospital readmission for patients with spine tumor.

From the Departments of *Orthopaedic Surgery and

Neurological Surgery, University of California San Francisco, San Francisco.

Address correspondence and reprint requests to Christopher Ames, MD, Department of Neurological Surgery, University of California San Francisco, 400 Parnassus Ave, San Francisco, CA 94143; E-mail: amesc@neurosurg.ucsf.edu

Acknowledgment date: February 1, 2014. Revision date: May 28, 2014. Acceptance date: June 29, 2014.

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, consultancy, employment, expert testimony, payment for lecture, royalties, grants, stocks, payment for development of educational presentations.

© 2014 by Lippincott Williams & Wilkins