157. Economic analysis of 90-day return to the emergency room and readmission after elective lumbar spine surgery: a single-center analysis of 5,444 patients

Abstract

BACKGROUND CONTEXT In the future, payers may not cover unplanned 90-day emergency room (ER) visits or readmissions after elective lumbar spine surgery. Prior studies using large administrative databases lack granularity, and/or use a proxy for actual cost. We analyzed a large, single-center database to identify risk factors and subsequent costs associated with 90-day ER visits and readmissions. PURPOSE To identify risk factors and subsequent costs associated with 90-day ER visits and readmissions. STUDY DESIGN/SETTING Retrospective longitudinal cohort from a single multisurgeon, spine specialty site PATIENT SAMPLE Patients undergoing elective lumbar spine surgeries from 2013-2017. OUTCOME MEASURES Ninety-day ER visits and readmissions. METHODS A prospective, multisurgeon, single-center database merged with hospital administrative data was queried for elective lumbar spine surgeries from 2013-2017. Predictive models were created for 90-day ER visits and readmissions. RESULTS Of 5,444 patients, 729 (13%) returned to the ER, most often for pain (144, 32%). Predictors of an ER visit were prior ER visit (pER, OR:2.4), zip code (OR:1.4) and number of chronic medical conditions (OR:1.4). 421 (8%) patients were readmitted, most frequently for wound infection (123, 2%), COPD exacerbation (24, 0.4%), and sepsis (23, 0.4%). Predictors for readmission were pER (OR:1.96), multiple chronic conditions (OR:1.69), obesity (non-obese, OR:0.49), race (African American, OR:1.43), admission status (ER admission, OR:2.29) and elevated HbA1c (OR:1.80). Average direct hospital cost for an ER visit was $1,659 and readmission was $7,322, costing the institution $5.1 million over the five-year study period. CONCLUSIONS Risk factors for 90-day ER visit and readmission after elective lumbar spine surgery include medical comorbidities and socioeconomic factors. Proper patient selection, appropriate postop pain management and optimization of modifiable risk factors prior to surgery can lower the 90-day ER visits and readmissions and reduce health care costs. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.