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Predictors of 90-Day Readmission in Children Undergoing Spinal Cord Tumor Surgery: A Nationwide Readmissions Database
M Burhan Janjua1, Sumanth Reddy2, Amer F Samdani3
1Department of Pediatric Neurosurgery, UT Southwestern Medical Center, Dallas, Texas, USA; Department of Neurosurgery, University of Pennsylvania Hospital, Philadelphia, Pennsylvania, USA.
Insights
The 90-day readmission rate for pediatric spinal tumor surgery is higher than 30-day rates, with younger age, Medicaid insurance, and malignant tumors predicting readmission. These readmissions incur significant costs.
Area of Science:
- Pediatric Oncology
- Neurosurgery
- Health Services Research
Background:
- Hospital readmissions after pediatric spinal tumor resection are common, potentially underestimating true readmission rates.
- A 30-day readmission window may not fully capture the readmission burden for these complex cases.
Purpose of the Study:
- To evaluate the 90-day readmission rate and identify associated risk factors in pediatric patients undergoing spinal tumor resection.
- To compare 30-day and 90-day readmission rates and their predictors.
Main Methods:
- Utilized the Nationwide Readmissions Database to analyze patient demographics, comorbidities, tumor characteristics, complications, and readmission data.
- Compared 30-day and 90-day readmission rates and performed logistic regression to identify predictors of readmission.
Main Results:
- The 90-day readmission rate (16.0%) was significantly higher than the 30-day rate (10.8%).
- Younger age (<5 years), Medicaid insurance, and malignant tumor type were significant predictors of 90-day readmission.
- Common reasons for 90-day readmission included spinal reoperation, chemotherapy/hematologic complications, and central nervous system disorders.
Conclusions:
- Unplanned hospital readmissions after pediatric spinal tumor resection are prevalent and costly.
- Younger age, Medicaid insurance, malignant tumors, and initial admission complications are key predictors of 90-day readmission, highlighting areas for intervention.
Objective:
A fair number of hospital admissions occur after 30 days; thus, the true readmission rate could have been underestimated. Therefore, we hypothesized that the 90-day readmission rate might better characterize the factors contributing to readmission for pediatric patients undergoing spinal tumor resection.
Methods:
The Nationwide Readmissions Database was used to study the patient demographic data, comorbidities, admissions, hospital course, spinal tumor behavior (malignant vs. benign), complications, revisions, and 30- and 90-day readmissions.
Results:
Of the 397 patients included in the 30-day cohort, 43 (10.8%) had been readmitted. In comparison, the 90-day readmission rate was significantly greater; 52 of 325 patients were readmitted (16.0%; P < 0.04). Patients aged 16-20 constituted the largest subgroup. However, the highest readmission rate was observed for patients aged <5 years (30-day, 21.7%; 90-day, 26.4%). Medicaid patients were more likely to be readmitted than were private insurance patients (30-day odds ratio [OR], 3.3 [P < 0.001]; 90-day OR, 2.29 [P < 0.02]). In both cohorts, patients with malignant tumors required readmission more often than did those with benign tumors (30-day OR, 2.78 [P < 0.02]; 90-day OR, 1.92 [P = 0.08]). In the 90-day cohort, the patients had been readmitted 26.4 days after discharge versus 10.6 days in the 30-day cohort. Within the 90-day cohort, 18.6% of the readmissions were for spinal reoperation, 28.3% for chemotherapy or hematologic complications, and 25.6% for other central nervous system disorders. The median charges for each readmission were ∼$50,000 and ∼$40,000 for the 30- and 90-day cohorts, respectively. Medicaid insurance, malignant tumors, and younger age were significant predictors of readmission in the 90-day cohort.
Conclusions:
The prevalence and charges associated with unplanned hospital readmissions after spinal tumor resection were remarkably high. Younger age, Medicaid insurance, malignant tumors, and complications during the initial admission were significant predictors of 90-day readmission.
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