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Causes and risk factors for 30-day unplanned readmissions after pediatric spinal deformity surgery
Christopher T Martin1, Andrew J Pugely, Yubo Gao
1From the Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA.
Insights
The 30-day unplanned readmission rate after pediatric spinal deformity surgery is low at 3.96%. Key risk factors include wound complications and gastrointestinal issues, particularly in neuromuscular cases.
Area of Science:
- Pediatric Orthopedics
- Spinal Surgery
- Healthcare Quality Improvement
Background:
- 30-day readmissions are a key healthcare quality metric.
- Limited data exists on pediatric spinal deformity surgery readmissions.
Purpose of the Study:
- Determine the incidence of 30-day unplanned readmissions.
- Identify risk factors and causes for readmission.
- Analyze pediatric spinal deformity surgery outcomes.
Main Methods:
- Retrospective review of a prospective, multicenter pediatric surgical outcomes registry.
- Analysis of patients undergoing spinal deformity surgery in 2012.
- Logistic regression to identify readmission predictors.
Main Results:
- Overall readmission rate was 3.96% (75/1890 patients).
- Higher readmissions observed in neuromuscular (6.83%) versus idiopathic (2.66%) and infantile (1.31%) cohorts.
- Top readmission causes: wound complications (73.3%) and gastrointestinal issues (13.3%).
- Independent predictors of readmission included isolated anterior spinal fusions, pulmonary abnormalities, and high American Society of Anesthesiologists class (3 or 4).
Conclusions:
- The 30-day unplanned readmission rate is low but significant.
- Discharge planning should focus on high-risk patients and common complications.
- Quality metrics should account for surgical complexity and patient comorbidities.
Study Design:
Retrospective review of a prospective cohort.
Objective:
To determine the incidence, risk factors, and causes for 30-day unplanned readmission after pediatric spinal deformity surgery.
Summary Of Background Data:
The government has targeted 30-day readmissions as a quality of care measure. However, few studies have analyzed readmission in pediatric cohorts.
Methods:
A multicenter registry designed to collect pediatric surgical outcomes was queried for patients undergoing spinal deformity surgery in 2012. Patients were divided into groups of those with and without an unplanned readmission within 30 days postoperatively. Univariate and multivariate logistic regression analyses were used to compare the cohorts, and to identify variables associated with readmission.
Results:
In total, 75 of 1890 pediatric patients undergoing spinal fusion for deformity had an unplanned 30-day readmission (3.96%). Readmissions were highest in the neuromuscular group (6.83%) and lowest in the idiopathic (2.66%) and infantile (1.31%) cohorts, (P < 0.01). The top reasons for readmission included wound complications (73.3%) and gastrointestinal disturbances (13.3%). In the univariate analysis, increasing surgical complexity, particularly fusions to the pelvis and isolated anterior spinal fusions, as well as increasing medical comorbidity burden were each associated with readmission (P < 0.05 for each). In the subsequent multivariate analysis, isolated anterior spinal fusions (odds ratio, 7.65; 95% confidence interval, 1.32-44.3) structural pulmonary abnormalities (odds ratio, 2.53; 95% confidence interval, 1.22-5.23) and an American Society of Anesthesiologists class of 3 or 4 (odds ratio, 2.18; 95% confidence interval, 1.07-4.47) were independently associated with readmission.
Conclusion:
The overall rate of 30-day unplanned readmissions after pediatric deformity surgery was low, but not insignificant. Surgeons should consider discharge optimization in the at-risk patient cohorts defined here, and should focus on wound complications and gastrointestinal disturbances to minimize readmissions. Quality reporting metrics should incorporate these risk factors to avoid unduly penalizing surgeons who take on complex cases.
Level Of Evidence:
3.
