Preoperative Emergency Department Visits Predict Potentially Unnecessary Expenditures After Transforaminal Lumbar...

Area of Science:

• Spine Surgery Outcomes
• Health Economics
• Healthcare Utilization

Background:

• Unplanned 30-day hospital readmissions after spine surgery incur financial penalties from the Centers for Medicare and Medicaid Services.
• Emergency department (ED) visits and readmissions represent significant financial burdens in spine surgery care.

Purpose of the Study:

• To determine if preoperative ED use predicts postoperative readmission, reoperation, and increased costs in patients undergoing transforaminal lumbar interbody fusion (TLIF).

Main Methods:

• A retrospective cohort study analyzed the Merative MarketScan database for TLIF procedures between July 2018 and June 2023.
• Primary outcome was postoperative ED visits; secondary outcomes included 30/90-day readmissions, complications, reoperations, and 30-day episode costs.
• Multivariate regression models assessed the association between preoperative ED visits and outcomes.

Main Results:

• Preoperative ED visits were associated with increased postoperative ED visits, 30-day complications, 90-day readmissions, and 90-day reoperations.
• A preoperative ED visit correlated with an average increase of $2,806.71 in 30-day episode-of-care costs.
• Chronic kidney disease (CKD) was the strongest predictor of 30-day complications.

Conclusions:

• Preoperative ED visits are linked to higher healthcare costs and utilization post-TLIF.
• These visits may indicate potential gaps in care and opportunities for intervention.
• Targeted preoperative counseling and interventions can potentially reduce unnecessary healthcare expenditures.