313. Risk factors for increased length of stay, reoperation and readmission following adult spinal deformity surgery in the elderly

Abstract

BACKGROUND CONTEXT Factors that influence length of stay (LOS), readmission, and reoperation after adult spinal deformity (ASD) operations are important to define in order to optimize outcomes and control costs. PURPOSE To identify predictors of LOS and 30-day and 90-day readmissions and reoperations following ASD operations. STUDY DESIGN/SETTING Single-center retrospective cohort. PATIENT SAMPLE Adults age >60 years who underwent operation (>3 levels) for lumbar spinal pathology. OUTCOME MEASURES Length of stay, reoperations, and readmissions at 30-days and 90-days post-operatively. METHODS Adults age>60 years who underwent operation (>3 levels) for lumbar spinal pathology between April 2015 and July 2017 at a single institution for ASD were reviewed. Demographics, comorbidities and surgical invasiveness were assessed for each patient and used as predictor variables for LOS and 30-day and 90-day readmissions and reoperations. RESULTS The study included 100 patients (avg age 69±6.8 years, male-32). Average LOS was 9.9 days (range, 4-101 days). Rates of readmission at 30-days and 90-days were 10% and 13%, respectively. Rates of reoperation at 30-days and 90-days were 7% and 11%, respectively. Preoperative factors significantly associated with LOS were age>74, history of wound healing difficulty, liver disease, and respiratory disease. Readmissions at 30-days were significantly associated with history of surgical site infection. Readmissions at 90-days were significantly associated with a history of renal disease and rheumatologic disorders. Reoperations at 30-days were significantly associated with a history of renal disease and preoperative narcotic dosages, as expressed by Morphine Milligram Equivalents, greater than 50mg. Reoperations at 90-days were significantly associated with history of renal disease and rheumatologic disorders. CONCLUSIONS In this single-center experience, preoperative factors associated with hospital LOS and 30-day and 90-day readmissions and revisions after operations for ASD span multiple domains including age, medical comorbidities and social factors. This information may be used to guide preoperative optimization and risk adjustment within alternative payment models. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.