Bernatz James T, Anderson Paul A
Department of Orthopedics and Rehabilitative Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Neurosurg Focus. 2015 Oct;39(4):E7. doi: 10.3171/2015.7.FOCUS1534.
OBJECT The rate of 30-day readmissions is rapidly gaining significance as a quality metric and is increasingly used to evaluate performance. An analysis of the present 30-day readmission rate in the spine literature is needed to aid the development of policies to decrease the frequency of readmissions. The authors examine 2 questions: 1) What is the 30-day readmission rate as reported in the spine literature? 2) What study factors impact the rate of 30-day readmissions? METHODS This study was registered with Prospera (CRD42014015319), and 4 electronic databases (PubMed, Cochrane Library, Web of Science, and Google Scholar) were searched for articles. A systematic review and meta-analysis was performed to assess the current 30-day readmission rate in spine surgery. Thirteen studies met inclusion criteria. The readmission rate as well as data source, time from enrollment, sample size, demographics, procedure type and spine level, risk factors for readmission, and causes of readmission were extrapolated from each study. RESULTS The pooled 30-day readmission rate was 5.5% (95% CI 4.2%-7.4%). Studies from single institutions reported the highest 30-day readmission rate at 6.6% (95% CI 3.8%-11.1%), while multicenter studies reported the lowest at 4.7% (95% CI 2.3%-9.7%). Time from enrollment had no statistically significant effect on the 30-day readmission rate. Studies including all spinal levels had a higher 30-day readmission rate (6.1%, 95% CI 4.1%-8.9%) than exclusively lumbar studies (4.6%, 95% CI 2.5%-8.2%); however, the difference between the 2 rates was not statistically significant (p = 0.43). The most frequently reported risk factors associated with an increased odds of 30-day readmission on multivariate analysis were an American Society of Anesthesiology score of 4+, operative duration, and Medicare/Medicaid insurance. The most common cause of readmission was wound complication (39.3%). CONCLUSIONS The 30-day readmission rate following spinal surgery is between 4.2% and 7.4%. The range, rather than the exact result, should be considered given the significant heterogeneity among studies, which indicates that there are factors such as demographics, procedure types, and individual institutional factors that are important and affect this outcome variable. The pooled analysis of risk factors and causes of readmission is limited by the lack of reporting in most of the spine literature.
30天再入院率作为一项质量指标正迅速变得重要起来，并越来越多地用于评估医疗表现。需要对脊柱领域文献中目前的30天再入院率进行分析，以协助制定降低再入院频率的政策。作者研究两个问题：1）脊柱领域文献报道的30天再入院率是多少？2）哪些研究因素会影响30天再入院率？方法：本研究在Prospera（CRD42014015319）注册，并检索了4个电子数据库（PubMed、Cochrane图书馆、科学网和谷歌学术）中的文章。进行了一项系统评价和荟萃分析，以评估脊柱手术目前的30天再入院率。13项研究符合纳入标准。从每项研究中推断出再入院率以及数据来源、入组后的时间、样本量、人口统计学特征、手术类型和脊柱节段、再入院的危险因素以及再入院原因。结果：汇总的30天再入院率为5.5%（95%CI 4.2%-7.4%）。单机构研究报告的30天再入院率最高，为6.6%（95%CI 3.8%-11.1%），而多中心研究报告的最低，为4.7%（95%CI
2.3%-9.7%）。入组后的时间对30天再入院率没有统计学上的显著影响。纳入所有脊柱节段的研究的30天再入院率（6.1%，95%CI 4.1%-8.9%）高于仅纳入腰椎的研究（4.6%，95%CI 2.5%-8.2%）；然而，这两个率之间的差异无统计学意义（p = 0.43）。多因素分析中最常报告的与30天再入院几率增加相关的危险因素是美国麻醉医师协会评分为4分以上、手术持续时间以及医疗保险/医疗补助保险。再入院最常见的原因是伤口并发症（39.3%）。结论：脊柱手术后的30天再入院率在4.2%至7.4%之间。鉴于各研究之间存在显著异质性，应考虑这个范围而非确切结果，这表明人口统计学特征、手术类型和个别机构因素等因素很重要且会影响这一结果变量。由于大多数脊柱领域文献缺乏相关报告，对再入院危险因素和原因的汇总分析受到限制。
