Cervical total disc replacement and anterior cervical discectomy and fusion: Reoperation rates, complications, and hospital resource utilization in 72 688 patients in the United States

Kavelin Rumalla, Kyle A. Smith, Paul M Arnold

Research output: Contribution to journalReview article

Abstract

BACKGROUND: Healthcare readmissions are important causes of increased cost and have profound clinical impact. Thirty-day readmissions in spine surgery have been well documented. However, rates, causes, and outcomes are not well understood outside 30 d. OBJECTIVE: To analyze 30- and 90-d readmissions for a retrospective cohort of anterior cervical discectomy and fusions (ACDF) and total disc replacement (TDR) for degenerative cervical conditions. METHODS: The Nationwide Readmissions Database approximates 50% of all US hospitalizations with patient identifiers to track patients longitudinally. Patients greater than 18 yr old were identified. Rates of readmission for 30 and 90 d were calculated. Predictor variables, complications, outcomes, and costs were analyzed via univariate and multivariable analyses. RESULTS: Between January and September 2013, 72 688 patients were identified. The 30- and 90-d readmission rates were 2.67% and 5.97%, respectively. The most prevalent reason for 30-d readmission was complication of medical/surgical care (20.3%), whereas for 90-d readmission it was degenerative spine etiology (19.2%). Common risk factors for 30- and 90-d readmission included older age, male gender, Medicare/Medicaid, prolonged initial length of stay, and various comorbidities. Unique risk factors for 30- and 90-d readmissions included adverse discharge disposition and mechanical implant-related complications, respectively.When comparing ACDF and TDR, ACDFs were associated with increased 90-d readmissions (6.0% vs 4.3%). The TDR cohort had a shorter length of stay, lower complication rate, and fewer adverse discharge dispositions. CONCLUSION: Identification of readmission causes and predictors is important to potentially allow for changes in periperative management. Decreasing readmissions would improve patient outcomes and reduce healthcare costs.

Original languageEnglish (US)
Pages (from-to)441-452
Number of pages12
JournalClinical Neurosurgery
Volume82
Issue number4
DOIs
StatePublished - Apr 1 2018

Fingerprint

Total Disc Replacement
Diskectomy
Reoperation
Length of Stay
Spine
Costs and Cost Analysis
Medicaid
Medicare
Health Care Costs
Comorbidity
Hospitalization
Databases
Delivery of Health Care

Keywords

  • Anterior cervical surgery
  • Disc replacement
  • Readmissions

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

@article{ccee6c2388f6472c8ab1ccd67e2bf37c,
title = "Cervical total disc replacement and anterior cervical discectomy and fusion: Reoperation rates, complications, and hospital resource utilization in 72 688 patients in the United States",
abstract = "BACKGROUND: Healthcare readmissions are important causes of increased cost and have profound clinical impact. Thirty-day readmissions in spine surgery have been well documented. However, rates, causes, and outcomes are not well understood outside 30 d. OBJECTIVE: To analyze 30- and 90-d readmissions for a retrospective cohort of anterior cervical discectomy and fusions (ACDF) and total disc replacement (TDR) for degenerative cervical conditions. METHODS: The Nationwide Readmissions Database approximates 50{\%} of all US hospitalizations with patient identifiers to track patients longitudinally. Patients greater than 18 yr old were identified. Rates of readmission for 30 and 90 d were calculated. Predictor variables, complications, outcomes, and costs were analyzed via univariate and multivariable analyses. RESULTS: Between January and September 2013, 72 688 patients were identified. The 30- and 90-d readmission rates were 2.67{\%} and 5.97{\%}, respectively. The most prevalent reason for 30-d readmission was complication of medical/surgical care (20.3{\%}), whereas for 90-d readmission it was degenerative spine etiology (19.2{\%}). Common risk factors for 30- and 90-d readmission included older age, male gender, Medicare/Medicaid, prolonged initial length of stay, and various comorbidities. Unique risk factors for 30- and 90-d readmissions included adverse discharge disposition and mechanical implant-related complications, respectively.When comparing ACDF and TDR, ACDFs were associated with increased 90-d readmissions (6.0{\%} vs 4.3{\%}). The TDR cohort had a shorter length of stay, lower complication rate, and fewer adverse discharge dispositions. CONCLUSION: Identification of readmission causes and predictors is important to potentially allow for changes in periperative management. Decreasing readmissions would improve patient outcomes and reduce healthcare costs.",
keywords = "Anterior cervical surgery, Disc replacement, Readmissions",
author = "Kavelin Rumalla and Smith, {Kyle A.} and Arnold, {Paul M}",
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TY - JOUR

T1 - Cervical total disc replacement and anterior cervical discectomy and fusion

T2 - Reoperation rates, complications, and hospital resource utilization in 72 688 patients in the United States

AU - Rumalla, Kavelin

AU - Smith, Kyle A.

AU - Arnold, Paul M

PY - 2018/4/1

Y1 - 2018/4/1

N2 - BACKGROUND: Healthcare readmissions are important causes of increased cost and have profound clinical impact. Thirty-day readmissions in spine surgery have been well documented. However, rates, causes, and outcomes are not well understood outside 30 d. OBJECTIVE: To analyze 30- and 90-d readmissions for a retrospective cohort of anterior cervical discectomy and fusions (ACDF) and total disc replacement (TDR) for degenerative cervical conditions. METHODS: The Nationwide Readmissions Database approximates 50% of all US hospitalizations with patient identifiers to track patients longitudinally. Patients greater than 18 yr old were identified. Rates of readmission for 30 and 90 d were calculated. Predictor variables, complications, outcomes, and costs were analyzed via univariate and multivariable analyses. RESULTS: Between January and September 2013, 72 688 patients were identified. The 30- and 90-d readmission rates were 2.67% and 5.97%, respectively. The most prevalent reason for 30-d readmission was complication of medical/surgical care (20.3%), whereas for 90-d readmission it was degenerative spine etiology (19.2%). Common risk factors for 30- and 90-d readmission included older age, male gender, Medicare/Medicaid, prolonged initial length of stay, and various comorbidities. Unique risk factors for 30- and 90-d readmissions included adverse discharge disposition and mechanical implant-related complications, respectively.When comparing ACDF and TDR, ACDFs were associated with increased 90-d readmissions (6.0% vs 4.3%). The TDR cohort had a shorter length of stay, lower complication rate, and fewer adverse discharge dispositions. CONCLUSION: Identification of readmission causes and predictors is important to potentially allow for changes in periperative management. Decreasing readmissions would improve patient outcomes and reduce healthcare costs.

AB - BACKGROUND: Healthcare readmissions are important causes of increased cost and have profound clinical impact. Thirty-day readmissions in spine surgery have been well documented. However, rates, causes, and outcomes are not well understood outside 30 d. OBJECTIVE: To analyze 30- and 90-d readmissions for a retrospective cohort of anterior cervical discectomy and fusions (ACDF) and total disc replacement (TDR) for degenerative cervical conditions. METHODS: The Nationwide Readmissions Database approximates 50% of all US hospitalizations with patient identifiers to track patients longitudinally. Patients greater than 18 yr old were identified. Rates of readmission for 30 and 90 d were calculated. Predictor variables, complications, outcomes, and costs were analyzed via univariate and multivariable analyses. RESULTS: Between January and September 2013, 72 688 patients were identified. The 30- and 90-d readmission rates were 2.67% and 5.97%, respectively. The most prevalent reason for 30-d readmission was complication of medical/surgical care (20.3%), whereas for 90-d readmission it was degenerative spine etiology (19.2%). Common risk factors for 30- and 90-d readmission included older age, male gender, Medicare/Medicaid, prolonged initial length of stay, and various comorbidities. Unique risk factors for 30- and 90-d readmissions included adverse discharge disposition and mechanical implant-related complications, respectively.When comparing ACDF and TDR, ACDFs were associated with increased 90-d readmissions (6.0% vs 4.3%). The TDR cohort had a shorter length of stay, lower complication rate, and fewer adverse discharge dispositions. CONCLUSION: Identification of readmission causes and predictors is important to potentially allow for changes in periperative management. Decreasing readmissions would improve patient outcomes and reduce healthcare costs.

KW - Anterior cervical surgery

KW - Disc replacement

KW - Readmissions

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U2 - 10.1093/neuros/nyx289

DO - 10.1093/neuros/nyx289

M3 - Review article

C2 - 28973385

AN - SCOPUS:85050679854

VL - 82

SP - 441

EP - 452

JO - Neurosurgery

JF - Neurosurgery

SN - 0148-396X

IS - 4

ER -