85. Unexpected postoperative clinical encounters with elective cervical spine surgery patients: can we predict them?

Abstract

BACKGROUND CONTEXT With reimbursement being increasingly tied to surgeon performance and various patient outcome measures, minimizing unexpected health care needs in the postoperative period is essential. It is unclear if comorbid psychiatric disorders, opioid consumption, or other factors impact the likelihood of an unscheduled, postoperative clinical encounter (ED visit or re-admission). PURPOSE The purpose of this study was to compare the (1) demographic factors, (2) psychiatric comorbidities, (3) pre- and postoperative patient reported outcomes, and (4) pre- and postoperative opioid requirements for patients undergoing elective cervical spine surgery requiring unscheduled, postoperative ED visits or re-admissions and for patients without unscheduled, postoperative clinical encounters. STUDY DESIGN/SETTING Retrospective chart review. PATIENT SAMPLE 179 consecutive patients who underwent elective cervical spine surgery at a single academic institution from 2014-2016 with a minimum of two years of follow up. OUTCOME MEASURES Peri-operative variables, preoperative ED visits, postoperative ED visits and hospital re-admissions within one year of surgery, complications, pre- and postoperative opioid consumption, Neck Disability Index (NDI) score, Visual analog scale (VAS) pain scores, Distressed Communities Index (DCI) score. METHODS Patient baseline characteristics, medical comorbidities, mood disorders, operative variables, and surgical complications (superficial and deep infection, wound complication, ED visits and re-admissions within one year of surgery, repeat operations) were recorded. Additionally, preoperative ED visits, postoperative opioid requirements, total opioid prescription quantities, and most recent date of opioid prescription were collected. Quantitative measurements of pain (VAS) and disease specific disability scores (NDI) were recorded preoperatively and three months after surgery. In addition, Distressed Communities Index (DCI) scores were recorded for each patient's home zip code. Continuous variables were compared with two-tailed independent t-tests, and categorical variables were compared using chi-square or Fisher Exact tests. RESULTS Of the 179 patients involved in this study, 15 (8.4%) patients had a postoperative ED visit (without re-admission) related to spine complaints and 21 (11.7%) patients had a postoperative re-admission related to the spine procedure. Those with a postoperative ED visit were more likely to have a worse DCI score (p CONCLUSIONS Approximately one-fifth of elective cervical spine surgery patients will visit the ED or go on to be admitted within one year of surgery due to spine-related complaints. While unplanned care for spine-related complications may be related in part to socioeconomic status or BMI, patients with a history of utilizing emergency care appear to be at the greatest risk of complication and health care utilization in the postoperative period. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.