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Michael D. Cusimano, Iryna Pshonyak, Michael Y. Lee and Gabriela Ilie

I n the last 20 years, the burdens of readmission on the health care system, hospitals, patients, and insurers have become apparent. Estimates are that Medicare spends over $15 billion on readmission-related expenditures yearly. 21 , 32 Readmission can be influenced by the quality of in-hospital care as well as follow-up care in the community, among other factors. 17 Compared with the US, in Canada, the interest in readmission is still growing. A recent report on readmissions by Health Canada found the current 28-day readmission rate for acute myocardial

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Michael D. Cusimano, Iryna Pshonyak, Michael Y. Lee and Gabriela Ilie

I n recent years, readmission has become a predominant issue due to its burdens on the health care system, hospitals, insurers, and patients. It has been estimated that the yearly cost to Medicare of unplanned readmissions is $17.4 billion. 24 In the US, reimbursement penalties have been instituted for early readmissions to improve quality of care under the Patient Protection and Affordable Care Act. 2 Considering the health and financial costs associated with readmission, it is not surprising that reducing readmission rates has been deemed a public health

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Scott L. Parker, Ahilan Sivaganesan, Silky Chotai, Matthew J. McGirt, Anthony L. Asher and Clinton J. Devin

I n an attempt to curb the current unsustainable growth in health care costs, the Centers for Medicare and Medicaid Services (CMS) has initiated several cost containment and quality improvement measures. 2 A very important example of these measures is the Hospital Readmissions Reduction Program (HRRP), which penalizes hospitals with relatively higher rates of Medicare readmissions. 7 , 9 The Department of Health and Human Services (HHS) stated that the HRRP will play a significant role in its new goals, applying to most inpatient hospitals, to tie an

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Rishi K. Wadhwa, Junichi Ohya, Todd D. Vogel, Leah Y. Carreon, Anthony L. Asher, John J. Knightly, Christopher I. Shaffrey, Steven D. Glassman and Praveen V. Mummaneni

O ver the past 2 decades, the rate of spinal surgery to treat degenerative disease has grown in the aging population. 10 , 22 Cost-containment is being sought in lumbar degenerative surgery to maintain financial sustainability. 18 Short-term hospital readmissions after surgery are costly and have been scrutinized following the enactment of the Patient Protection and Affordable Care Act (PPACA) of 2010. 12 , 14 The minimization of readmission-related expenses, of which Medicare paid nearly $17 billion, is seen as a potential source of cost-containment. 11

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Brandon A. Sherrod, James M. Johnston and Brandon G. Rocque

U nplanned hospital readmissions after surgery present medical and financial challenges for health care systems and have emerged as an important measure of health care quality and efficiency. 2 , 14 , 18 Recent health care reforms have led the Centers for Medicare & Medicaid Services to penalize providers for higher rates of unplanned readmissions. 7 Furthermore, unplanned readmissions provide a quality outcome metric that may prove useful in quality improvement, patient risk stratification, and counseling patients and families prior to operations. 2

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Logan P. Marcus, Brandon A. McCutcheon, Abraham Noorbakhsh, Ralitza P. Parina, David D. Gonda, Clark Chen, David C. Chang and Bob S. Carter

H ospital readmission within 30 days of discharge is a major contributor to the high cost of health care in the US. Medicare payments for unplanned 30-day readmission episodes were responsible for $17.4 billion or roughly 17% of the total Medicare hospital payments for 2004. 10 , 14 As a result, 30-day readmissions have become an important metric for measuring the quality of patient care. The Patient Protection and Affordable Care Act of 2010 authorized Medicare to use financial penalties to incentivize hospitals to reduce 30-day readmissions

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Syed I. Khalid, Ryan Kelly, Adam Carlton, Owoicho Adogwa, Patrick Kim, Arjun Ranade, Jessica Moreno, Samantha Maasarani, Rita Wu, Patrick Melville and Jonathan Citow

only to decrease procedure expenses but also to improve patient outcomes by eliminating the hospital stay and thus preventing the adverse effects associated with the nosocomial environment. The increase in frequency of these procedures has made it necessary to evaluate their efficacy and safety in the ambulatory setting. A retrospective study by Adamson et al. of 1000 ACDF patients who underwent 1- or 2-level procedures showed that all 90-day morbidities were similar between outpatient and inpatient cohorts. 1 These included 30-day readmission (1.8% vs 2.9%, p = 0

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Darryl Lau, Andrew K. Chan, Alexander A. Theologis, Dean Chou, Praveen V. Mummaneni, Shane Burch, Sigurd Berven, Vedat Deviren and Christopher Ames

a detailed retrospective assessment of the index hospital costs associated with the surgical management of extradural primary and metastatic spinal tumors at a single institution. We compare the direct costs of primary and metastatic spinal tumors and identify the independent factors associated with cost. The independent risk factors for 90-day readmission are also examined. Methods Patients The study cohort represents a consecutive series of adult patients (18 years or older) who underwent surgery for a spinal tumor between 2008 and 2013 at a single

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Niketh Bhashyam, Rafael De la Garza Ramos, Jonathan Nakhla, Rani Nasser, Ajit Jada, Taylor E. Purvis, Daniel M. Sciubba, Merritt D. Kinon and Reza Yassari

limited data on the short-term outcome of ACDF versus CDR, particularly in terms of early reoperation and readmission rates. Thus, the purpose of this study was to compare 30-day readmission and reoperation rates between patients who underwent single-level ACDF and those who underwent CDR. Methods Study Sample For this study, we used the 2013–2014 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database; the study was deemed exempt from review by the local institutional review board. The NSQIP is a prospectively collected

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Hormuzdiyar H. Dasenbrock, Timothy R. Smith, Robert F. Rudy, William B. Gormley, M. Ali Aziz-Sultan and Rose Du

A lthough unplanned 30-day readmission and reoperation have been increasingly used as metrics to assess the quality of care physicians and hospitals provide, their utility as quality indicators—particularly in surgical patients—is contentious. 28 Hospitals now incur penalties for high readmission rates in specified circumstances, including pneumonia. 16 , 28 Medical patients often require readmission for exacerbation of the same condition treated during their initial hospital stay (known as the index hospitalization), an argument used to support the use of