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30- and 90-Day Unplanned Readmission Rates, Causes, and Risk Factors After Cervical Fusion

A Single-Institution Analysis

Zaki, Omar BS; Jain, Nikhil MD; Yu, Elizabeth M. MD; Khan, Safdar N. MD

doi: 10.1097/BRS.0000000000002937

Study Design. Retrospective cohort study

Objective. To study 30- and 90-day readmission rates, causes, and risk factors after anterior cervical discectomy and fusion (ACDF) and posterior cervical fusion (PCF).

Summary of Background Data. Existing data on readmission after cervical fusion is majorly derived from national databases. Given their inherent limitations in accuracy, follow-up available, and missing data, we intend to add to literature from our institutional analysis.

Methods. Patients who underwent ACDF and PCF for degenerative cervical pathology in 2013 and 2014 were identified for the study. Comprehensive chart review was performed to record demographics and clinical patient profile. Hospital readmission within 30 and 90 days was identified, and the causes and management were recorded. Binary logistic regression analysis was done to study risk factors for readmission. ACDF and PCF were studied separately.

Results. Our analysis included a total of 549 patients, stratified as 389 ACDFs and 160 PCFs. The 30- and 90-day unplanned readmission rate was 5.1% and 7.7% after ACDF. These rates were 11.2% and 16.9% after PCF. The most common cause of readmission was systemic infection and sepsis after ACDF and PCF (31.4% and 25.8% of readmitted, respectively), followed by pulmonary complications after ACDF (14.3% of readmitted) and wound complications after PCF (19.4% of readmitted). Predictors of readmission after ACDF included heart failure, history of malignancy, history of deep vein thrombosis/pulmonary embolism, and any intraoperative complication. In the PCF cohort, history of ischemic heart disease, increasing number of fusion levels and longer length of stay were independently predictive.

Conclusion. The rates, causes, and risk factors of readmission after ACDF and PCF have been identified. There is variation in published data regarding the incidence and risk factors for readmission after cervical fusion; however, majority of readmissions occur due to medical complications and systemic infection.

Level of Evidence: 3

This retrospective single institutional analysis of 549 cervical fusions found a 90-day readmission rate of 7.7% and 16.9% after anterior and posterior cervical fusion, respectively. Existing literature shows variation in incidence and risk factors for readmission after cervical fusion; however, the majority occur due to medical complications and systemic infection.

College of Medicine, The Ohio State University, Columbus, OH

Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH.

Address correspondence and reprint requests to Safdar N. Khan, MD, The Benjamin R. and Helen Slack Wiltberger Endowed Chair in Orthopaedic Spine Surgery, Associate Professor and Chief, Division of Spine Surgery, Department of Orthopaedics, Adjunct Associate Professor, Department of Integrated Systems Engineering, Clinical Faculty, Spine Research Institute (, Wexner Medical Center at The Ohio State University, 725 Prior Hall, Columbus, OH 43210; E-mail:

Received 18 May, 2018

Revised 8 August, 2018

Accepted 26 October, 2018

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 © 2018 Wolters Kluwer Health, Inc. All rights reserved.