Use of the LACE+ index to predict readmissions after single-level lumbar fusion

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  • 1 Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia;
  • | 2 McKenna EpiLog Fellowship in Population Health, University of Pennsylvania, Philadelphia; and
  • | 3 The West Chester Statistical Institute and Department of Mathematics, West Chester University, West Chester, Pennsylvania
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OBJECTIVE

Spinal fusion is one of the most common neurosurgical procedures. The LACE (length of stay, acuity of admission, Charlson Comorbidity Index [CCI] score, and emergency department [ED] visits within the previous 6 months) index was developed to predict readmission but has not been tested in a large, homogeneous spinal fusion population. The present study evaluated use of the LACE+ score for outcome prediction after lumbar fusion.

METHODS

LACE+ scores were calculated for all patients (n = 1598) with complete information who underwent single-level, posterior-only lumbar fusion at a single university medical system. Logistic regression was performed to assess the ability of the LACE+ score as a continuous variable to predict hospital readmissions within 30 days (30D), 30–90 days (30–90D), and 90 days (90D) of the index operation. Secondary outcome measures included ED visits and reoperations. Subsequently, patients with LACE+ scores in the bottom decile were exact matched to the patients with scores in the top 4 deciles to control for sociodemographic and procedural variables.

RESULTS

Among all patients, increased LACE+ score significantly predicted higher rates of readmissions in the 30D (p < 0.001), 30–90D (p = 0.001), and 90D (p < 0.001) postoperative windows. LACE+ score also predicted risk of ED visits at all 3 time points and reoperations at 30–90D and 90D. When patients with LACE+ scores in the bottom decile were compared with patients with scores in the top 4 deciles, higher LACE+ score predicted higher risk of readmissions at 30D (p = 0.009) and 90D (p = 0.005). No significant difference in hospital readmissions was observed between the exact-matched cohorts.

CONCLUSIONS

The present results suggest that the LACE+ score demonstrates utility in predicting readmissions within 30 and 90 days after single-level lumbar fusion. Future research is warranted that utilizes the LACE+ index to identify strategies to support high-risk patients in a prospective population.

ABBREVIATIONS

CCI = Charlson Comorbidity Index; CEM = coarsened exact matching; ED = emergency department; EHR = electronic health record; LACE = length of stay, acuity of admission, Charlson Comorbidity Index score, and emergency department visits within the previous 6 months; LACE+ = LACE plus age, sex, and history of hospital admissions; 30D = 30 days; 30–90D = 30–90 days; 90D = 90 days.

Supplementary Materials

    • Supplemental Table 1 (PDF 440 KB)

Illustration from Lee et al. (pp 822–829). Copyright Sun Joo Kim. Published with permission.

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  • 1

    Fischer C, Lingsma HF, Marang-van de Mheen PJ, Kringos DS, Klazinga NS, Steyerberg EW. Is the readmission rate a valid quality indicator? A review of the evidence. PLoS One. 2014;9(11):e112282.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2

    Kocher RP, Adashi EY. Hospital readmissions and the Affordable Care Act: paying for coordinated quality care. JAMA. 2011;306(16):17941795.

  • 3

    Lawson EH, Hall BL, Louie R, Ettner SL, Zingmond DS, Han L, et al. Association between occurrence of a postoperative complication and readmission: implications for quality improvement and cost savings. Ann Surg. 2013;258(1):1018.

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

    Akins PT, Harris J, Alvarez JL, Chen Y, Paxton EW, Bernbeck J, Guppy KH. Risk factors associated with 30-day readmissions after instrumented spine surgery in 14,939 patients: 30-day readmissions after instrumented spine surgery. Spine (Phila Pa 1976).2015;40(13):10221032.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5

    Torio CM, Moore BJ. National inpatient hospital costs: the most expensive conditions by payer, 2013: Statistical Brief #204 Healthcare Cost and Utilization Project (HCUP) Statistical Briefs.Agency for Healthcare Research and Quality (US);2016.

    • Search Google Scholar
    • Export Citation
  • 6

    van Walraven C, Dhalla IA, Bell C, Etchells E, Stiell IG, Zarnke K, et al. Derivation and validation of an index to predict early death or unplanned readmission after discharge from hospital to the community. CMAJ. 2010;182(6):551557.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    van Walraven C, Wong J, Forster AJ. LACE+ index: extension of a validated index to predict early death or urgent readmission after hospital discharge using administrative data. Open Med. 2012;6(3):e90e100.

    • Search Google Scholar
    • Export Citation
  • 8

    Winter E, Haldar D, Glauser G, Caplan IF, Shultz K, McClintock SD, et al. The LACE+ index as a predictor of 90-day supratentorial tumor surgery outcomes. Neurosurgery. 2020;87(6):11811190.

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

    Glauser G, Caplan IF, Winter E, Goodrich S, McClintock SD, Atluri P, Malhotra NR. Evaluation of the LACE+ index for short-term cardiac surgery outcomes: a coarsened exact match study. Ann Thorac Surg. 2020;110(1):173182.

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

    Glauser G, Winter E, Caplan IF, Goodrich S, McClintock SD, Guzzo TJ, Malhotra NR. The LACE+ index as a predictor of 30-day patient outcomes in a urologic surgery population: a coarsened exact match study. Urology. 2019;134:109115.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11

    Glauser G, Winter E, Caplan IF, Goodrich S, McClintock SD, Srinivas SK, Malhotra NR. Composite score for outcome prediction in gynecologic surgery patients. J Healthc Qual. 2021;43(3):163173.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Dimentberg R, Caplan IF, Winter E, Glauser G, Goodrich S, McClintock SD, et al. Prediction of adverse outcomes within 90 days of surgery in a heterogeneous orthopedic surgery population. J Healthc Qual. 2021;43(4):e53e63.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13

    Winter E, Detchou DK, Glauser G, Strouz K, McClintock SD, Marcotte PJ, Malhotra NR. Predicting patient outcomes after far lateral lumbar discectomy. Clin Neurol Neurosurg. 2021;203:106583.

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

    Winter E, Glauser G, Caplan IF, Goodrich S, McClintock SD, Kovach SJ III, et al. The LACE+ index as a predictor of 30-day patient outcomes in a plastic surgery population: a coarsened exact match study. Plast Reconstr Surg. 2020;146(3):296e305e.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15

    Linzey JR, Nadel JL, Wilkinson DA, Rajajee V, Daou BJ, Pandey AS. Validation of the LACE index (Length of stay, Acuity of admission, Comorbidities, Emergency department use) in the adult neurosurgical patient population. Neurosurgery. 2020;86(1):E33E37.

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

    Martin BI, Mirza SK, Spina N, Spiker WR, Lawrence B, Brodke DS. Trends in lumbar fusion procedure rates and associated hospital costs for degenerative spinal diseases in the United States, 2004 to 2015.Spine (Phila Pa 1976).2019;44(5):369376.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Gawande A. Why doctors hate their computers. The New Yorker. November 5, 2018.Accessed October 7, 2021. https://www.newyorker.com/magazine/2018/11/12/why-doctors-hate-their-computers

    • Search Google Scholar
    • Export Citation
  • 18

    Farooqi AS, Borja AJ, Detchou DKE, Glauser G, Strouz K, McClintock SD, Malhotra NR. Duration of overlap during lumbar fusion does not predict outcomes. Clin Neurol Neurosurg. 2021;205:106610.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19

    Iacus SM, King G, Porro G. Causal inference without balance checking: coarsened exact matching. Polit Anal. 2012;20(1):124.

  • 20

    Seicean A, Seicean S, Neuhauser D, Benzel EC, Weil RJ. The influence of race on short-term outcomes after laminectomy and/or fusion spine surgery. Spine (Phila Pa 1976).2017;42(1):3441.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21

    Lad SP, Bagley JH, Kenney KT, Ugiliweneza B, Kong M, Bagley CA, et al. Racial disparities in outcomes of spinal surgery for lumbar stenosis. Spine (Phila Pa 1976).2013;38(11):927935.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22

    Aladdin DEH, Tangel V, Lui B, Pryor KO, Witkin LR, White RS. Black race as a social determinant of health and outcomes after lumbar spinal fusion surgery: a multistate analysis, 2007 to 2014.Spine (Phila Pa 1976).2020;45(10):701711.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23

    Brown CW, Orme TJ, Richardson HD. The rate of pseudarthrosis (surgical nonunion) in patients who are smokers and patients who are nonsmokers: a comparison study. Spine (Phila Pa 1976).1986;11(9):942943.

    • Search Google Scholar
    • Export Citation
  • 24

    Berman D, Oren JH, Bendo J, Spivak J. The effect of smoking on spinal fusion. Int J Spine Surg. 2017;11(4):29.

  • 25

    Webb ML, Nelson SJ, Save AV, Cui JJ, Lukasiewicz AM, Samuel AM, et al. Of 20,376 lumbar discectomies, 2.6% of patients readmitted within 30 days: surgical site infection, pain, and thromboembolic events are the most common reasons for readmission. Spine (Phila Pa 1976).2017;42(16):12671273.

    • Search Google Scholar
    • Export Citation
  • 26

    Alosh H, Riley LH III, Skolasky RL. Insurance status, geography, race, and ethnicity as predictors of anterior cervical spine surgery rates and in-hospital mortality: an examination of United States trends from 1992 to 2005.Spine (Phila Pa 1976).2009;34(18):19561962.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27

    Turan A, Mascha EJ, Roberman D, Turner PL, You J, Kurz A, et al. Smoking and perioperative outcomes. Anesthesiology. 2011;114(4):837846.

  • 28

    Wilson JR, Tetreault LA, Schroeder G, Harrop JS, Prasad S, Vaccaro A, et al. Impact of elevated body mass index and obesity on long-term surgical outcomes for patients with degenerative cervical myelopathy: analysis of a combined prospective dataset. Spine (Phila Pa 1976).2017;42(3):195201.

    • Search Google Scholar
    • Export Citation

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