Economic analysis of 90-day return to the emergency room and readmission after elective lumbar spine surgery: a single-center analysis of 5444 patients

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  • Norton Leatherman Spine Center, Louisville, Kentucky
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OBJECTIVE

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

ABBREVIATIONS ASA = American Society of Anesthesiologists; CMS = Centers for Medicare and Medicaid Services; COPD = chronic obstructive pulmonary disease; DRG = Diagnosis-Related Group; ER = emergency room; HCUP = Healthcare Cost and Utilization Project; LOS = length of stay; NRD = National Readmission Database; NSQIP = National Surgical Quality Improvement Program; QOD = Quality Outcomes Database; SID = State Inpatient Databases; VAS = visual analog scale.

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Contributor Notes

Correspondence Leah Y. Carreon: Norton Leatherman Spine Center, Louisville, KY. leah.carreon@nortonhealthcare.org.

INCLUDE WHEN CITING Published online October 2, 2020; DOI: 10.3171/2020.6.SPINE191477.

Disclosures Dr. Carreon reports being an employee of Norton Healthcare and the University of Southern Denmark; being a consultant for the National Spine Health Foundation; receiving support of non–study-related clinical or research effort overseen by the author from OREF, NIH, ISSG, SRS, TSRH, Pfizer, Lifesciences Corp., Intellirod, Cerapedics, Medtronic, Empirical Spine, and NeuroPoint Alliance; and being a member of the Editorial Advisory Boards for Spine, the Spine Journal, and Spine Deformity and a member of the University of Louisville Institutional Review Board. Dr. Djurasovic reports being a consultant for Medtronic and NuVasive. Dr. Glassman reports being an employee of Norton Healthcare, a consultant for K2M/Stryker and Medtronic, and a patent holder for Medtronic; receiving clinical or research support for the study described (includes equipment or material) from NuVasive; receiving royalties from Medtronic; and serving as chair of the American Spine Registry and past president of the Scoliosis Research Society. Dr. Gum reports being an employee of Norton Healthcare and a consultant for Medtronic, DePuy, K2M/Stryker, Scuity, PacMed, and NuVasive; receiving clinical or research support for the study described (includes equipment or material) from Intellirod, Integra, Pfizer, and the International Spine Study Group; having direct stock ownership in Cingulate Therapeutics; being a patent holder for Medtronic; and receiving royalties from Acuity.

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