Risk factors for 90-day reoperation and readmission after lumbar surgery for lumbar spinal stenosis

Restricted access

OBJECTIVE

The objective of this study was to evaluate the incidence and risk factors for 90-day readmission and reoperation after elective surgery for lumbar spinal stenosis (LSS).

METHODS

The authors performed a retrospective consecutive cohort analysis of patients undergoing posterior lumbar decompression with or without fusion for LSS with claudication from January 2014 through December 2015.

RESULTS

Data were collected on 1592 consecutive patients. The mean age at surgery was 67.4 ± 10.1 years and 45% of patients were female. The 90-day reoperation rate was 4.7%, and 69.3% of the reoperations occurred within the first 30 days. The 90-day readmission rate was 7.2%. Multivariable analysis showed that postoperative development of a surgical site infection (SSI; odds ratio [OR] 14.09, 95% confidence interval [CI] 7.86–25.18), acute kidney injury (AKI; OR 6.76, 95% CI 2.39–19.57), and urinary tract infection (UTI; OR 3.96, 95% CI 2.43–6.37), as well as a history of congestive heart failure (CHF; OR 3.03, 95% CI 1.69–5.28), were significant risk factors for readmission within 90 days. Male sex (OR 0.60, 95% CI 0.38–0.92) was associated with decreased odds for readmission. With regards to reoperation, development of SSI (OR 25.06, 95% CI 13.54–46.51), sepsis (OR 7.63, 95% CI 1.52–40.59), UTI (OR 2.54, 95% CI 1.31–4.76), and increased length of stay (LOS; OR 1.25, 95% CI 1.17–1.33) were found to be significant risk factors. A subsequent analysis found that morbid obesity (OR 6.99), history of coronary artery disease (OR 2.263), increased duration of surgery (OR 1.004), and LOS (OR 1.07) were significant risk factors for developing an SSI.

CONCLUSIONS

Overall, this study found rates of 4.7% and 7.2% for reoperation and readmission, respectively, within 90 days: 30.7% of the reoperations and 44.7% of the readmissions occurred beyond the first 30 days. A diagnosis of SSI, AKI, UTI, and history of CHF were significant factors for readmission, while male sex was associated with decreased odds for readmission. A diagnosis of SSI, sepsis, UTI, and increased LOS were found to be significant predictors for reoperation. Understanding 90-day complication rates is imperative because there has been increased discussion and healthcare policy extending the global postoperative window to 90 days. Current literature supports a readmission rate of 3%–9% after spine surgery. However, this literature either is limited to a 30-day window or does not stratify between different types of spine surgeries.

ABBREVIATIONS AKI = acute kidney injury; BPH = benign prostate hyperplasia; CAD = coronary artery disease; CHF = congestive heart failure; CI = confidence interval; CMS = Centers for Medicare and Medicaid Services; COPD = chronic obstructive pulmonary disease; DM = diabetes mellitus; EBL = estimated blood loss; LOS = length of stay; LSS = lumbar spinal stenosis; OR = odds ratio; POUR = postoperative urinary retention; SSI = surgical site infection; UTI = urinary tract infection.

Article Information

Correspondence Haariss Ilyas: The Cleveland Clinic, Cleveland, OH. haariss.b.ilyas@gmail.com.

INCLUDE WHEN CITING Published online April 5, 2019; DOI: 10.3171/2019.1.SPINE18878.

Disclosures Dr. Mroz reports being a consultant for Stryker. Dr. Steinmetz reports being a consultant for Intellirod and Globus; receiving support of non–study-related clinical or research effort from Globus; and receiving honoraria and royalties from Stryker, Globus, Zimmer Biomet, and Elsevier.

© AANS, except where prohibited by US copyright law.

Headings

References

  • 1

    Ahn DKPark HSChoi DJKim TWChun THYang JH: The difference of surgical site infection according to the methods of lumbar fusion surgery. J Spinal Disord Tech 25:E230E2342012

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2

    Akamnonu CCheriyan TGoldstein JAErrico TJBendo JA: Ninety-day readmissions after degenerative cervical spine surgery: a single-center administrative database study. Int J Spine Surg 9:192015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Akamnonu CCheriyan TGoldstein JALafage VErrico TJBendo JA: Unplanned hospital readmission after surgical treatment of common lumbar pathologies: rates and causes. Spine (Phila Pa 1976) 40:4234282015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Baaj AALang GHsu WCAvila MJMao JSedrakyan A: 90-day readmission after lumbar spinal fusion surgery in New York State between 2005 and 2014: a 10-year analysis of a statewide cohort. Spine (Phila Pa 1976) 42:170617162017

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Bernatz JTAnderson PA: Thirty-day readmission rates in spine surgery: systematic review and meta-analysis. Neurosurg Focus 39(4):E72015

  • 6

    Birkmeyer JDDimick JBBirkmeyer NJO: Measuring the quality of surgical care: structure, process, or outcomes? J Am Coll Surg 198:6266322004

  • 7

    Chaichana KLBydon MSantiago-Dieppa DRHwang LMcLoughlin GSciubba DM: Risk of infection following posterior instrumented lumbar fusion for degenerative spine disease in 817 consecutive cases. J Neurosurg Spine 20:45522014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Cloyd JMAcosta FL JrAmes CP: Complications and outcomes of lumbar spine surgery in elderly people: a review of the literature. J Am Geriatr Soc 56:131813272008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Covaro AVilà-Canet Gde Frutos AGUbierna MTCiccolo FCaceres E: Management of degenerative lumbar spinal stenosis: an evidence-based review. EFORT Open Rev 1:2672742017

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Drazin DShirzadi ARosner JEboli PSafee MBaron EM: Complications and outcomes after spinal deformity surgery in the elderly: review of the existing literature and future directions. Neurosurg Focus 31(4):E32011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Fink ASItani KMCampbell DC Jr: Assessing the quality of surgical care. Surg Clin North Am 87:837852vi2007

  • 12

    Flexman AMCharest-Morin RStobart LStreet JRyerson CJ: Frailty and postoperative outcomes in patients undergoing surgery for degenerative spine disease. Spine J 16:131513232016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Fry DEPine MLocke DReband ATorres ZPine G: Medicare inpatient and 90-day postdischarge adverse outcomes in carotid artery surgery. Surgery 158:105610642015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Gani FLucas DJKim YSchneider EBPawlik TM: Understanding variation in 30-day surgical readmission in the era of accountable care: effect of the patient, surgeon, and surgical subspecialties. JAMA Surg 150:104210492015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Golubovsky JLIlyas HChen JTanenbaum JEMroz TESteinmetz MP: Risk factors and associated complications for postoperative urinary retention after lumbar surgery for lumbar spinal stenosis. Spine J 18:153315392018

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Ibrahim AMNathan HThumma JRDimick JB: Impact of the Hospital Readmission Reduction Program on surgical readmissions among Medicare beneficiaries. Ann Surg 266:6176242017

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Jiang JTeng YFan ZKhan SXia Y: Does obesity affect the surgical outcome and complication rates of spinal surgery? A meta-analysis. Clin Orthop Relat Res 472:9689752014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Karhade AVVasudeva VSDasenbrock HHLu YGormley WBGroff MW: Thirty-day readmission and reoperation after surgery for spinal tumors: a National Surgical Quality Improvement Program analysis. Neurosurg Focus 41(2):E52016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Komiya RKamintani KKubo EHattori MKataoka HIwase Y: [Perioperative management and postoperative complication rates of patients on dual antiplatelet therapies after coronary drug eluting stent implantation.] Masui 63:629352014 (Japanese)

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Lee MJCizik AMHamilton DChapman JR: Predicting surgical site infection after spine surgery: a validated model using a prospective surgical registry. Spine J 14:211221172014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Lucas DJPawlik TM: Readmission after surgery. Adv Surg 48:1851992014

  • 22

    Ma XLZhao XWMa JXLi FWang YLu B: Effectiveness of surgery versus conservative treatment for lumbar spinal stenosis: a system review and meta-analysis of randomized controlled trials. Int J Surg 44:3293382017

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Marquez-Lara ANandyala SVSankaranarayanan SNoureldin MSingh K: Body mass index as a predictor of complications and mortality after lumbar spine surgery. Spine (Phila Pa 1976) 39:7988042014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    McCormack RAHunter TRamos NMichels RHutzler LBosco JA: An analysis of causes of readmission after spine surgery. Spine (Phila Pa 1976) 37:126012662012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Park JIBliss DZChi CLDelaney CWWestra BL: Factors associated with healthcare-acquired catheter-associated urinary tract infections: analysis using multiple data sources and data mining techniques. J Wound Ostomy Continence Nurs 45:1681732018

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Patel NBagan BVadera SMaltenfort MGDeutsch HVaccaro AR: Obesity and spine surgery: relation to perioperative complications. J Neurosurg Spine 6:2912972007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    Plate JFBrown MLWohler ADSeyler TMLang JE: Patient factors and cost associated with 90-day readmission following total hip arthroplasty. J Arthroplasty 31:49522016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Pugely AJMartin CTGao YMendoza-Lattes S: Causes and risk factors for 30-day unplanned readmissions after lumbar spine surgery. Spine (Phila Pa 1976) 39:7617682014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29

    Puvanesarajah VNourbakhsh AHassanzadeh HShimer ALShen FHSingla A: Readmission rates, reasons, and risk factors in elderly patients treated with lumbar fusion for degenerative pathology. Spine (Phila Pa 1976) 41:193319382016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30

    Rea KLe-Jenkins URutledge C: A technology intervention for nurses engaged in preventing catheter-associated urinary tract infections. Comput Inform Nurs 36:3053132018

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31

    Rihn JARadcliff KHilibrand ASAnderson DTZhao WLurie J: Does obesity affect outcomes of treatment for lumbar stenosis and degenerative spondylolisthesis? Analysis of the Spine Patient Outcomes Research Trial (SPORT). Spine (Phila Pa 1976) 37:193319462012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

    Samuel AMMoore HGCunningham ME: Treatment for degenerative lumbar spondylolisthesis: current concepts and new evidence. Curr Rev Musculoskelet Med 10:5215292017

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33

    Steib AHadjiat FSkibba WSteib JP: Focus on perioperative management of anticoagulants and antiplatelet agents in spine surgery. Orthop Traumatol Surg Res 97 (6 Suppl):S102S1062011

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 34

    Umer AShapiro DSHughes CRoss-Richardson CEllner S: The use of an indwelling catheter protocol to reduce rates of postoperative urinary tract infections. Conn Med 80:1972032016

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35

    Wadhwa RKOhya JVogel TDCarreon LYAsher ALKnightly JJ: Risk factors for 30-day reoperation and 3-month readmission: analysis from the Quality and Outcomes Database lumbar spine registry. J Neurosurg Spine 27:1311362017

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36

    Wang MCShivakoti MSparapani RAGuo CLaud PWNattinger AB: Thirty-day readmissions after elective spine surgery for degenerative conditions among US Medicare beneficiaries. Spine J 12:9029112012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37

    Weinstein JNLurie JDTosteson TDHanscom BTosteson ANBlood EA: Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. N Engl J Med 356:225722702007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38

    Weinstein JNTosteson TDLurie JDTosteson ABlood EHerkowitz H: Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial. Spine (Phila Pa 1976) 35:132913382010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39

    Xenos ESLyden JAKorosec RLDavenport DL: Ninety-day readmission risks, rates, and costs after common vascular surgeries. Am J Manag Care 20:e432e4382014

    • Search Google Scholar
    • Export Citation
  • 40

    Yadla SGhobrial GMCampbell PGMaltenfort MGHarrop JSRatliff JK: Identification of complications that have a significant effect on length of stay after spine surgery and predictive value of 90-day readmission rate. J Neurosurg Spine 23:8078112015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41

    Yadla SMalone JCampbell PGMaltenfort MGHarrop JSSharan AD: Obesity and spine surgery: reassessment based on a prospective evaluation of perioperative complications in elective degenerative thoracolumbar procedures. Spine J 10:5815872010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42

    Zhou HDella PRRoberts PGoh LDhaliwal SSDhaliwal S: Utility of models to predict 28-day or 30-day unplanned hospital readmissions: an updated systematic review. BMJ Open 6:e0110602016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43

    Zuckerman RBSheingold SHOrav EJRuhter JEpstein AM: Readmissions, observation, and the Hospital Readmissions Reduction Program. N Engl J Med 374:154315512016

    • Crossref
    • Search Google Scholar
    • Export Citation

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 83 83 83
Full Text Views 38 38 38
PDF Downloads 65 65 65
EPUB Downloads 0 0 0

PubMed

Google Scholar