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Unplanned Hospital Readmissions and Reoperations After Pediatric Spinal Fusion Surgery
Amit Jain1, Varun Puvanesarajah, Emmanuel N Menga
1From the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD.
Insights
Pediatric spinal fusion surgery has an 8% unplanned readmission rate, often due to wound complications. Certain diagnoses and increased fusion levels are key risk factors for readmission after spinal fusion.
Area of Science:
- Orthopedic Surgery
- Pediatric Spine Surgery
- Spinal Deformity Correction
Background:
- The incidence and primary drivers of unplanned readmissions and reoperations following pediatric spinal fusion are not well-documented.
- Understanding these outcomes is crucial for improving patient care and optimizing surgical protocols.
Purpose of the Study:
- To determine the rates and causes of unplanned 90-day readmissions and reoperations after pediatric spinal fusion.
- To identify patient-specific and surgical factors associated with increased risk of readmission and reoperation.
Main Methods:
- Retrospective review of 1002 pediatric patients (ages 10-18) who underwent spinal fusion for deformity correction between 2000 and 2013.
- Analysis included patient demographics, surgical variables (e.g., levels fused, blood loss), diagnoses, and outcomes within 90 days of surgery.
- Univariate and multivariate logistic regression models were employed to identify significant risk factors (P < 0.05).
Main Results:
- The overall 90-day unplanned readmission rate was 8.0%, with reoperation rates at 3.8%.
- Most common readmission causes included wound dehiscence (1.8%), deep wound infection (1.5%), and pulmonary complications (1%).
- Multivariate analysis revealed that specific diagnoses (congenital, genetic/syndromic scoliosis, cerebral palsy, neuromuscular disorders) were significantly associated with higher readmission and reoperation rates.
Conclusions:
- The 8% unplanned readmission rate after pediatric spinal fusion highlights the need for vigilant post-operative monitoring, particularly for wound complications.
- Factors such as increased intraoperative blood loss, a higher number of fused vertebral levels, and specific patient diagnoses are significant risk factors for unplanned readmissions.
Study Design:
Retrospective review.
Objective:
To investigate the rates and reasons for unplanned readmissions and reoperation after pediatric spinal fusion surgery at our institution and to identify risk factors by analyzing patient and surgical characteristics. Unplanned readmission and reoperation were defined as unplanned events within 90 days of the index surgery.
Summary Of Background Data:
The rate of unplanned readmission and reoperation after pediatric spinal fusion surgery is not well established.
Methods:
Clinical records were reviewed for all children who underwent spinal fusion surgical procedures for spinal deformity correction performed by 1 surgeon from 2000 through 2013 at our institution. Inclusion criteria were age of 10 to 18 years at surgery, fusion spanning more than 5 vertebral levels, and 3 months of clinical or radiographical follow-up (1002 patients met these criteria). Univariate and multivariate logistic regression models were created. Statistical significance was set at a P value of less than 0.05 for all analyses.
Results:
The overall 90-day unplanned readmission and reoperation rates were 8.0% and 3.8%, respectively. The most common causes of readmission were wound dehiscence (1.8%), deep wound infection (1.5%), pulmonary complications (1%), and superficial wound infection (0.9%). Univariate analysis showed that readmission was significantly associated with a higher number of levels fused, greater estimated blood loss, longer length of stay, and certain diagnoses; reoperation was significantly associated with a higher number of levels fused and certain diagnoses. On multivariate analysis, only patient diagnosis was found to be significantly associated with readmission and reoperation; patients with congenital scoliosis, genetic or syndromic scoliosis, cerebral palsy, and other neuromuscular disorders had significantly higher rates.
Conclusion:
Unplanned readmission rate after pediatric spinal fusion surgery was 8%, most commonly for wound dehiscence and deep and superficial infections. Increased intraoperative blood loss, higher number of levels fused, and certain diagnoses are risk factors for unplanned readmission.
Level Of Evidence:
4.
