Manoharan S R, Baker D K, Pasara S M, Ponce B, Deinlein D, Theiss S M
Division of Orthopaedic Surgery, University of Alabama Medical Center, FOT 950, 510 20th St South, Birmingham, AL 35233, USA.
Division of Orthopaedic Surgery, University of Alabama Medical Center, FOT 950, 510 20th St South, Birmingham, AL 35233, USA.
Spine J. 2016 Jul;16(7):862-6. doi: 10.1016/j.spinee.2016.03.014. Epub 2016 Mar 11.
Adult spine deformity surgery (ASDS) is a significantly invasive procedure with a relatively high complication rate. The thirty-day hospital readmission rate following surgery is an important quality measure monitored by multiple quality reporting agencies.
This study seeks to determine the risk factors for 30- day readmission rate in patients undergoing ASDS and identify the risk factors associated with readmission.
This is a retrospective multicenter study.
The National Surgical Quality Improvement Program database, which is a large multi-institutional database, was searched for patients that underwent ASDS from 2011 to 2013. The patients were identified by searching seven Current Procedural Terminology codes most commonly used for spinal deformity surgery. Twenty-seven preoperative variables, including patient demographics and comorbidities, intraoperative parameters, and postoperative complications were analyzed to identify risk factors for readmission.
A total of 747 adult patients who underwent ASDS were identified. Of the 747 patients, 7.5% (56/747) were readmitted within 30 days. The most common causes of readmission were infection (n=11), hematoma or seroma formation (n=5), and postoperative pain (n=3). Univariate analysis revealed male gender (p=.038, odds ratio [OR]=1.83) and pulmonary embolism before discharge (p=.048, OR=8.44) to be associated with readmission. In multivariate analysis, obesity (p=.047, OR=1.80), peripheral vascular disease (p=.045, OR=17.52), pulmonary embolism before discharge (p=.012, OR=10.35), and total or partial dependent preoperative functional health status (p=.041, OR=2.45), were found to be independent risk factors for readmission. Age, smoking, and resident involvement during surgical procedure were among the many factors not associated with increased risk of readmission.
The 30-day readmission rate for ASDS is increasingly becoming a significant health-care quality indicator. Patients with the aforementioned significant risk factors should be closely followed up, which can potentially avoid subsequent readmission.
成人脊柱畸形手术（ASDS）是一种侵入性较大的手术，并发症发生率相对较高。术后30天内的医院再入院率是多个质量报告机构监测的一项重要质量指标。
本研究旨在确定接受ASDS手术患者30天再入院率的风险因素，并识别与再入院相关的风险因素。
这是一项回顾性多中心研究。
在国家外科质量改进计划数据库（一个大型多机构数据库）中搜索2011年至2013年接受ASDS手术的患者。通过搜索脊柱畸形手术最常用的七个当前手术操作术语代码来识别患者。分析了27个术前变量，包括患者人口统计学和合并症、术中参数以及术后并发症，以确定再入院的风险因素。
共识别出747例接受ASDS手术的成年患者。在这747例患者中，7.5%（56/747）在30天内再次入院。再入院的最常见原因是感染（n = 11）、血肿或血清肿形成（n = 5）以及术后疼痛（n = 3）。单因素分析显示男性（p = 0.038，比值比[OR] = 1.83）和出院前肺栓塞（p = 0.048，OR = 8.44）与再入院相关。多因素分析发现，肥胖（p = 0.047，OR = 1.80）、外周血管疾病（p = 0.045，OR = 17.52）、出院前肺栓塞（p = 0.012，OR = 10.35）以及术前功能健康状况完全或部分依赖（p = 0.041，OR = 2.45）是再入院的独立风险因素。年龄、吸烟以及手术过程中住院医师的参与是众多与再入院风险增加无关的因素。
ASDS的30天再入院率日益成为一项重要的医疗质量指标。具有上述显著风险因素的患者应密切随访，这有可能避免随后的再入院。
