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Hospital-Acquired Conditions in Adult Spinal Deformity Surgery

Predictors for Hospital-Acquired Conditions and Other 30-Day Postoperative Outcomes

Di Capua, John MHS, BS; Somani, Sulaiman BS; Kim, Jun S. MD; Leven, Dante M. DO, PT; Lee, Nathan J. BS; Kothari, Parth BS; Cho, Samuel K. MD

doi: 10.1097/BRS.0000000000001840

Study Design. A retrospective study of prospectively collected data.

Objective. The aim of this study was to identify risk factors in developing hospital-acquired conditions (HACs) and association of HACs with other 30-day complications in the adult spinal deformity (ASD) population.

Summary of Background Data. HACs are subject to a nonpayment policy by the Center for Medicare and Medicaid Services and provide an incentive for medical institutions to improve patient safety. HACs in the ASD population may further exacerbate the already high rates of postoperative morbidity and mortality.

Methods. The 2010 to 2014 ACS-NSQIP database was queried using Current Procedural Terminology (CPT) codes for adults who had fusion for spinal deformity. Patients were divided into two cohorts on the basis of the development of an HAC, as defined as a case of surgical site infection, urinary tract infection, or venous thromboembolism. Univariate and multivariate logistic regression analyses were employed to determine predictors for HACs and association of HACs with other 30-day postoperative outcomes.

Results. Five thousand eight hundred nineteen patients met the inclusion criteria for the study of whom 313 (5.4%) had an HAC. Multivariate logistic regression analysis revealed that age 61 to 70 versus ≤50 years [odds ratio (OR) = 1.58, 1.10–2.27, P = 0.013], 71 to 80 versus ≤50 years (OR = 1.94, 1.31–2.87, P = 0.001), and >80 versus ≤50 years (OR = 2.30, 1.21–4.37, P = 0.011), dependent/partially dependent versus independent functional status (OR = 1.74, 1.13–2.68, P = 0.011), combined versus anterior surgical approach (OR = 2.46, 1.43–4.24, P = 0.001), and posterior versus anterior surgical approach (OR = 1.64, 1.19–2.25, P = 0.002), osteotomies (OR = 1.61, 1.22–2.13, P = 0.001), steroid use (OR = 2.19, 1.39–3.45, P = 0.001), obesity (OR = 1.38, 1.09–1.74, P = 0.007), and operation time ≥4 hours (OR = 2.42, 1.82–3.21, P < 0.001) were predictive factors in developing an HAC.

Conclusion. Several modifiable and nonmodifiable factors (age, functional status, surgical approach, utilization of osteotomies, steroid use, obesity, and operation time ≥4 hours) were associated with developing an HAC. HACs were also risk factors for other postoperative complications.

Level of Evidence: 3

Department of Orthopaedics Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.

Address correspondence and reprint requests to Samuel K. Cho, MD, 5 East 98th Street, Box 1188, New York, NY 10029. E-mail:

Received 21 March, 2016

Revised 9 June, 2016

Accepted 16 July, 2016

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: grants.

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved