• TaylorBlake E SBESDepartment of Neurosurgery, Rutgers New Jersey Medical School, Newark, NJ.Department of Neurosurgery, Robert Wood Johnson University Hospital, New Brunswick, NJ.Department of Neurosurgery, Saint Barnabas Medical Center, Livingston, NJ.Ru, Patrick Hilden, HansenRosemary T BehmerRTBRutgers New Jersey Medical School, Newark NJ., Anil Nanda, and John L Gillick.
• Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, NJ.
• Spine. 2021 Oct 1; 46 (19): 1302-1314.

Study DesignRetrospective cohort study of the Nationwide Readmissions Database (NRD).ObjectiveTo determine causes of and independent risk factors for 30- and 90-day readmission in a cohort of anterior cervical discectomy and fusion (ACDF) patients.Summary Of Background DataIdentifying populations at high-risk of 30-day readmission is a priority in healthcare reform so as to reduce cost and patient morbidity. However, among patients undergoing ACDF, nationally-representative data have been limited, and have seldom described 90-day readmissions, early reoperation, or socioeconomic influences.MethodsWe queried the NRD, which longitudinally tracks 49.3% of hospitalizations, for all adult patients undergoing ACDF. We calculated the rates of, and determined reasons for, readmission and reoperation at 30 and 90 days, and determined risk factors for readmission at each timepoint.ResultsWe identified 50,126 patients between January and September 2014. Of these, 2294 (4.6%) and 4152 (8.3%) were readmitted within 30 and 90 days of discharge, respectively, and were most commonly readmitted for infections, medical complications, and dysphagia. The characteristics most strongly associated with readmission were Medicare or Medicaid insurance, length of stay greater than or equal to 4 days, three or more comorbidities, and non-routine discharge, whereas surgical factors (e.g., greater number of vertebrae fused) were more modest. By 30 and 90 days, 8.2% and 11.7% of readmitted patients underwent an additional spinal procedure, respectively.ConclusionOur analysis uses the NRD to thoroughly characterize readmission in the general ACDF population. Readmissions are often delayed (after 30 days), strongly associated with insurance status, and many result in reoperation. Our results are crucial for risk-stratifying future ACDF patients and developing interventions to reduce readmission.Level of Evidence: 3.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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