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Of 20,376 Lumbar Discectomies, 2.6% of Patients Readmitted Within 30 Days

Surgical Site Infection, Pain, and Thromboembolic Events Are the Most Common Reasons for Readmission

Webb, Matthew L., MD; Nelson, Stephen J., MD; Save, Ameya V., MD; Cui, Jonathan J., BS; Lukasiewicz, Adam M., MD; Samuel, Andre M., MD; Diaz-Collado, Pablo J., MD; Bohl, Daniel D., MD, MPH§; Ondeck, Nathaniel T., BS; McLynn, Ryan P., BS; Grauer, Jonathan N., MD

doi: 10.1097/BRS.0000000000002014
SURGERY
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SDC

Study Design. A retrospective cohort study of prospectively collected data.

Objective. As an initial effort to address readmissions after lumbar discectomy, reasons for hospital readmission are identified and discussed.

Summary of Background Data. Lumbar discectomy is a commonly performed procedure. The Affordable Care Act codifies penalties for hospital readmissions. New quality-based reimbursements tied to readmissions call for a better understanding of the causes of readmission after procedures such as lumbar discectomy.

Methods. Lumbar discectomies performed in 2012 to 2014 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Patient demographics, surgical variables, and reasons for readmissions within 30 days were recorded. Pearson chi square was used to compare rates of demographics and surgical variables between readmitted and nonreadmitted patients. Multivariate regression was used to identify risk factors for readmission.

Results. Of 20,376 lumbar discectomies, 533 patients (2.62%) were readmitted within 30 days of surgery. The most common reasons for readmission were surgical site infections (n = 130, 0.64% of all discectomies, 24.4% of all readmissions), followed by pain issues (n = 89, 0.44%, 16.7%), and thromboembolic events (43, 0.21%, 8.1%). Overall time to readmission was 13.0 ± 8.0 days (mean ± standard deviation). Factors most associated with readmission after lumbar discectomy were higher American Society of Anesthesiologists class (relative risk = 1.49, P < 0.001) and prolonged operative time (relative risk = 1.41, P = 0.002).

Conclusion. Surgical site infection, postoperative pain, and thromboembolic events were the most common reasons for readmission after lumbar discectomy. These findings identify potential areas for quality improvement initiatives.

Level of Evidence: 3

Department of Orthopedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA

Department of Orthopedics and Rehabilitation, Yale School of Medicine, New Haven, CT

Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, Cornell University, New York, NY

§Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.

Address correspondence and reprint requests to Jonathan N. Grauer, MD, Department of Orthopedics and Rehabilitation, Yale School of Medicine, PO Box 208071, New Haven, CT 06520-8071; E-mail: jonathan.grauer@yale.edu

Received 22 August, 2016

Revised 10 November, 2016

Accepted 23 November, 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: consultancy, grants, expert testimony.

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