211. Patient, surgery, and hospital-related risk factors for hospital acquired conditions following common spinal procedures during inpatient stays

Abstract

<h3>BACKGROUND CONTEXT</h3> A total of 48,771 hospital-acquired conditions (HACs) have been reported in United States hospitals. These incidents resulted in excess costs of more than $2 billion, which translated to roughly $40,000 per patient per HAC. Along with this direct fiscal burden, enduring an HAC added on average 8.17 days to each patient's hospital stay, which can lead to indirect hidden costs. <h3>PURPOSE</h3> To critically analyze the classical and novel risk factors of HACs following the most prevalent inpatient spine procedures; spinal fusion (463,200 cases/year) and laminectomy (438,200 cases/year). <h3>STUDY DESIGN/SETTING</h3> Systematic review of observational cohort studies. <h3>PATIENT SAMPLE</h3> This study included 6,382 patients who underwent spine fusion or laminectomy. <h3>OUTCOME MEASURES</h3> Patient-, surgical-, hospital-, related risk factors and genetic associations. <h3>METHODS</h3> Several online databases were searched. Using illustrated figures and diagrams, we aim to provide spine surgeons with the knowledge and evidence about the economic impact, patient-, surgery-, and hospital-related risk factors of HACs. Additionally, we present the novel risk factors such as genetic biomarkers. <h3>RESULTS</h3> Patients undergoing fusion and laminectomy experience HACs at rates of 1.4% and 6.5%, respectively. The incidence of HACs most commonly comprises falls and trauma (87%) and SSIs (11%) for thoracolumbar fusion patients, while laminectomy patients experience venous thromboembolism (VTE) (1.4%) and surgical site infection (SSI) (0.2%) most frequently. Increased age is correlated with higher incidence of HACs. Complication rates in those over 65 are as high as 13.46% with wound complications (1.2%-1.69% of cases) and deep vein thrombosis (DVT) (2.1-2.2%) occurring at rates greater than that of those under 65. BMI less than 40 is associated with increased risk of VTE events and SSI, whereas those over 40 have higher risk of urinary tract infection (UTI). Patients who have had previous spinal surgery have a strong risk of developing wound complications (4.6% vs 1.0% among those without prior surgery). Insulin-dependent diabetes (OR=1.72) may increase the rate of complications and deep SSI following thoracolumbar spinal surgery (p=0.050). Steroid use (OR=1.55) may increase a patient's likelihood of complication. Patients with a preoperative psychiatric disorder are at greater risk of a surgical complication. Regarding hospital-related factors, increased operative time is associated with greater risk of HACs. In patients over the age of 75, the length of operation time (p=0.003) is a contributing factor to wound complications. Moreover, teaching hospitals and those with larger bed sizes may be associated with increased risk for HACs. Lastly, weekend admissions are associated with a 45.3% HAC incidence rate compared to a 4.59% rate in weekday admissions. However, higher surgeon volume is associated with lower complications. The pre-admission testing for novel genetic biomarkers of HACs could stratify the risk of HACs for patients. Patients with higher concentrations of miR-582, miR-195, miR- 532, nitric oxide synthase 3 polymorphism are at higher risk to develop VTE. <h3>CONCLUSIONS</h3> Identifying patient-, surgery-, and hospital- related risk factors in the setting of fusion and laminectomy is crucial to providing patients with optimal care and avoiding the penalties of HACs. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.