276. Factors associated with cost of 30-day and 90-day readmissions following anterior cervical discectomy and fusion: insights from the Nationwide Readmissions Database

Abstract

BACKGROUND CONTEXT The rising cost of spine surgery and the resultant economic burden has attracted the attention of health policy makers. Readmissions constitute a significant economic burden to the health care system. With the introduction of bundled payments leading to a higher financial risk for providers, literature is needed to evaluate the factors that influence the cost of readmissions following spine surgery. PURPOSE We analyzed the Healthcare Cost and Utilization Project (HCUP) Nationwide Readmissions Database (NRD) to determine the hospital, patient and clinical factors that contribute to cost of 30- and 90-day readmissions after elective anterior cervical discectomy and fusion (ACDF) for degenerative spine disease. STUDY DESIGN/SETTING Retrospective study using a national administrative database. PATIENT SAMPLE Patients undergoing elective ACDF between 2012 and 2015 queried from the Nationwide Readmissions Database (NRD). OUTCOME MEASURES Cost of 30-day and 90-day readmissions. METHODS We queried the NRD for patients undergoing elective ACDF during 2012-2015Q3. The NRD provides national readmissions data collected for all types of payers and the uninsured, as well as across a wide geographic distribution of hospitals in the United States. Multivariable linear regression was performed to establish the factors associated with cost of each 30/90-day readmission episode (REC). We also determined the procedure-related and medical diagnosis at readmission associated with higher cost of hospitalization. RESULTS A total of 4,792 30-day readmissions from 4,512 patients and 8,156 90-day readmissions from 7,198 patients were included analysis. The average 30-day REC was $11,843 (95% CI: $11,390- $12,297) and the average 90-day REC was $14,353 (95% CI: $13,962 - $14,744). Number of procedures at index admission, length of stay at index admission, and days since index admission that the readmission occurred were the top predictors of readmission cost. Other important predictors (p CONCLUSIONS In this analysis from a national database, we determined the factors associated with cost of readmissions following elective ACDF. Our results indicate that a significant economic burden of readmissions is due to medical diagnoses, apart from procedure related complications. Our analyses may aid policy makers and stakeholders in designing better reimbursement policies for future in order to drive down costs associated with spinal surgery and its associated sequelae. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.