Differences in 30- and 90-Day Readmission Rates After Surgical Treatment for Lumbar Degenerative Disc Disease in Elderly Patients (³ð65 Years): A National Readmission Database Study
Abstract INTRODUCTION For spine surgery performed for degenerative disc disease (DDD), a paucity of nationwide studies exists describing common complications and readmission rates. The aim of this study was to investigate the differences and complications associated with 30- and 90-d readmissions following surgical treatment for lumbar DDD in the elderly. METHODS The Nationwide Readmission Database years 2013 to 2015 was queried. Elderly patients (>65 yr old) undergoing anterior lumbar interbody fusion (ALIF), posterior lumbar fusion (PLIF)/posterolateral lumbar fusion (PLF), or anterior and posterior lumbar fusion (APLF) for lumbar DDD were identified. Unique patient linkage numbers were used to follow patients and identify 30- and 31 to 90-d readmission rates. Patients were grouped by no readmission (Non-R), readmission within 30 d (30-R), and readmission within 31 to 90 d (90-R). RESULTS We identified 11 651 elderly patients undergoing ALIF, PLIF/PLF, or APLF for lumbar DDD, with 1213 (10.4%) patients encountering a readmission (30-R: n = 812[7.0%]; 90-R: n = 401[3.4%]; Non-R: n = 10 438). The greatest proportion of each cohort had 2 to 3 vertebral levels fused (30-R: 63.7%, 90-R: 69.2%, Non-R: 70.2%). Iliac crest bone graft was the most common fusion agent used (30-R: 59.9%, 90-R: 51.4%, Non-R: 53.5%), followed by bone morphogenetic protein (30-R: 24.6%, 90-R: 22.9%, Non-R: 21.2%). The most common inpatient complications observed were acute posthemorrhagic anemia (30-R: 26.6%, 90-R: 22.3%, Non-R: 18.2%), postoperative infection (30-R: 6.2%, 90-R: 9.7%, Non-R: 3.5%), and genitourinary complication (30-R: 7.7%, 90-R: 2.7%, Non-R: 3.5%). The most prevalent 30- and 90-d complications seen among the readmitted cohort were postoperative infection (30-R: 18.7%, 90-R: 8.9%), device complications (30-R: 5.2%, 90-R: 9.1%), and sepsis (30-R: 6.9%, 90-R: 4.9%). On multivariate regression analysis, obesity, chronic pulmonary disease, smoking, and any complication during index admission were independently associated with 30-d readmission; private insurance and coagulopathy were independently associated with 90-d readmission. CONCLUSION Our study suggests that 30- and 90-d readmissions for treatment of lumbar DDD in the elderly are common, and that multiple patient-level factors independently predict hospital readmission.
