Predictors of 30-Day Readmission Following Cervical Laminoplasty in 3,085 Patients: An American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Database Study.

Abstract

Background Cervical laminoplasty is a surgical alternative to laminectomy and fusion for treating multi-level cervical spondylotic myelopathy. There is limited evidence evaluating readmission incidence and risk factors following cervical laminoplasty. Here, we provide a retrospective review evaluating preoperative risk for 30-day readmission following cervical laminoplasty. Methodology The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients undergoing laminoplasty as defined by Current Procedural Terminology codes 63050 and 63051. Patients were then categorized based on whether 30-day readmission occurred, and preoperative risk factors were examined. Continuous and categorical variables were analyzed using Student's t-test or Fisher's exact test. Multivariate regression analysis was performed for each variable, with p-values of <0.05 considered significant. Results In total, 3,085 patients were identified as undergoing posterior cervical laminoplasty. Of these, 2,938 patients did not require readmission, and 147 patients were readmitted, representing a 4.77% 30-day readmission rate. For all patients, sepsis (odds ratio (OR) = 5.58, p = 0.03), dialysis (OR = 3.46, p = 0.01), American Society of Anesthesiologists class >2 (OR = 1.69, p = 0.011), and hypertension (OR = 1.51, p = 0.04) were predictive of readmission. A subgroup analysis was performed for all geriatric patients (aged >65). In total, 1,353 patients were identified, of whom 76 were readmitted, demonstrating a readmission rate of 5.62%. For the elderly patients, hypertension (OR = 1.98, confidence interval (CI) = 1.04-3.75, p = 0.04) and independent status (OR = 0.39, CI = 0.21-0.74, p = 0.004) were predictive of readmission. Conclusions Assessment of predictors for readmission is important for patient education and setting appropriate clinical expectations for surgeons and providers. Preoperative hypertension, dialysis, and sepsis were risk factors for 30-day readmission following cervical laminoplasty, with functional status being a unique risk factor for elderly patients.