Wiley Marcel R, Carreon Leah Y, Djurasovic Mladen, Glassman Steven D, Khalil Yehia H, Kannapel Michelle, Gum Jeffrey L
J Neurosurg Spine. 2020 Oct 2;34(1):89-95. doi: 10.3171/2020.6.SPINE191477. Print 2021 Jan 1.
In the future, payers may not cover unplanned 90-day emergency room (ER) visits or readmissions after elective lumbar spine surgery. Prior studies using large administrative databases lack granularity and/or use a proxy for actual cost. The purpose of this study was to identify risk factors and subsequent costs associated with 90-day ER visits and readmissions after elective lumbar spine surgery.
A prospective, multisurgeon, single-center electronic medical record was queried for elective lumbar spine fusion surgeries from 2013 to 2017. Predictive models were created for 90-day ER visits and readmissions.
Of 5444 patients, 729 (13%) returned to the ER, most often for pain (n = 213, 29%). Predictors of an ER visit were prior ER visit (OR 2.5), underserved zip code (OR 1.4), and number of chronic medical conditions (OR 1.4). In total, 421 (8%) patients were readmitted, most frequently for wound infection (n = 123, 2%), exacerbation of chronic obstructive pulmonary disease (n = 24, 0.4%), and sepsis (n = 23, 0.4%). Predictors for readmission were prior ER visit (OR 1.96), multiple chronic conditions (OR 1.69), obesity (nonobese, OR 0.49), race (African American, OR 1.43), admission status (ER admission, OR 2.29), and elevated hemoglobin A1c (OR 1.80). The mean direct hospital cost for an ER visit was $1971, with 75% of visits costing less than $1890, and the average readmission cost was $7347, with 75% of readmissions costing less than $8820. Over the 5-year study period, the cost to the institution for 90-day return ER visits was $5.1 million.
Risk factors for 90-day ER visit and readmission after elective lumbar spine surgery include medical comorbidities and socioeconomic factors. Proper patient counseling, appropriate postoperative pain management, and optimization of modifiable risk factors prior to surgery are areas to focus future efforts to lower 90-day ER visits and readmissions and reduce healthcare costs.
未来，医保支付方可能不会为择期腰椎手术后计划外的90天急诊室就诊或再入院提供费用报销。以往使用大型管理数据库的研究缺乏详细信息，且/或使用代理数据来估算实际费用。本研究的目的是确定择期腰椎手术后90天急诊室就诊和再入院的风险因素及后续费用。
对2013年至2017年期间进行择期腰椎融合手术的前瞻性、多外科医生、单中心电子病历进行查询。建立了90天急诊室就诊和再入院的预测模型。
在5444例患者中，729例（13%）返回急诊室，最常见的原因是疼痛（n = 213，29%）。急诊室就诊的预测因素为既往急诊室就诊（OR 2.5）、医疗服务不足的邮政编码区域（OR 1.4）和慢性疾病数量（OR 1.4）。共有421例（8%）患者再次入院，最常见的原因是伤口感染（n = 123，2%）、慢性阻塞性肺疾病加重（n = 24，0.4%）和脓毒症（n = 23，0.4%）。再入院的预测因素为既往急诊室就诊（OR 1.96）、多种慢性疾病（OR 1.69）、肥胖（非肥胖者，OR 0.49）、种族（非裔美国人，OR 1.43）、入院状态（急诊入院，OR 2.29）和糖化血红蛋白升高（OR 1.80）。急诊室就诊的平均直接医院费用为1971美元，75%的就诊费用低于1890美元，再入院的平均费用为7347美元，75%的再入院费用低于8820美元。在5年的研究期间，该机构因90天内返回急诊室就诊的费用为510万美元。
择期腰椎手术后90天急诊室就诊和再入院的风险因素包括合并症和社会经济因素。对患者进行适当的咨询、进行适当的术后疼痛管理以及在手术前优化可改变的风险因素，是未来降低90天急诊室就诊和再入院率以及降低医疗成本的重点努力方向。
