Photo Credit: Pornpak Khunatorn
The following is a summary of “Previous Emergency Department Admission Is Associated With Increased 90-Day Readmission Following Cervical Spine Surgery,” published in the June 2023 issue of Clinical Spine Surgery by Amakiri et al.
This was a retrospective case-control study design. The investigation aimed to determine whether a prior admission to the emergency department was associated with an increased risk for readmission within 90 days following elective cervical spinal fusion. The incidence of reoperations for cervical spine fusion has increased, necessitating the enhancement of postoperative patient outcomes. There are currently no studies assessing the impact of emergency department visits before elective cervical spine surgery on the risk of readmission within 90 days. This study sought to identify a novel risk factor for readmission following elective cervical fusion to address this knowledge gap. The National Readmissions Database for 2016–2018 was queried for patients 18 years and older who underwent elective cervical fusion.
Prior emergency admissions were defined in the Nationwide Readmissions Database database using the variable HCUP_ED. The X2 test was used to evaluate the univariate analysis of patient demographics, comorbidities, discharge disposition, and perioperative complication, followed by multivariate logistic regression. Results indicated that 2,766 patients met the inclusion criteria, and 18.62% were readmitted within 90 days. Independent predictors of 90-day readmission were identified as intraoperative complications, gastrointestinal complications, valvular, uncomplicated hypertension, peripheral vascular disorders, chronic obstructive pulmonary disease, malignancy, and having fewer than three Charlson comorbidities.
Patients with more than three Charlson comorbidities (OR=0.04, 95% CI 0.01–0.12, P<0.001) and neurological complications (OR=0.29, 95% CI 0.10–0.86, P=0.026) had a decreased likelihood of 90-day readmission. Notably, previous visits to the emergency department within the preceding calendar year were a new independent predictor of 90-day readmission (OR=9.74, 95% CI 6.86–13.83, P<0.001). Emergency department admission history positively correlates with 90-day readmission after elective cervical fusion. Screening patients undergoing cervical fusion for this history and optimizing outcomes for these patients may reduce readmission rates at 90 days.