• Steven Glassman, Leah Y Carreon, Mikkel Andersen, Anthony Asher, Soren Eiskjær, Martin Gehrchen, Shiro Imagama, Ken Ishii, Takahashi Kaito, Yukihiro Matsuyama, Hiroshi Moridaira, Praveen Mummaneni, Christopher Shaffrey, and Morio Matsumoto.
• *Norton Leatherman Spine Center. 210 East Gray Street, Suite 900, Louisville, Kentucky 40202, USA †Rygkirurgisk Center Middelfart, Sygehus Lillebælt, Østre Hougvej 55, 5500 Middelfart, Denmark ‡Carolina Neurosurgery & Spine, 225 Baldwin Ave, Charlotte, NC 28204, USA §Department of Orthopedic Surgery, Aalborg University Hospital, Hobrovej 19-22, 9000 Aalborg Denmark ¶Spine Unit, Department of Orthopaedic Surgery 2162, Rigshospitalet, University Hospital of Copenhagen, Blegdamsvej 9, 2100 København, Denmark ||Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, 466-8560 Japan **Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan ††Department of Orthopedic Surgery, Faculty of Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan ‡‡Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu-city, Shizuoka, 431-3192, Japan §§Department of Orthopaedic Surgery, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu-machi, Shimotsuga-gun, Tochigi, 321-0293, Japan ¶¶Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Ave. Rm. M779, San Francisco, CA 94143-0112, USA ||||University of Virginia, Department of Neurosurgery, PO Box 800212, Charlottesville, VA 22908, USA.
• Spine. 2017 Jan 31.

Study DesignRetrospective review of three spine surgery databases.ObjectivesThe purpose of this study is to determine if predictors of hospital readmission and Surgical Site Infection (SSI) after lumbar fusion will be the same in US, Denmark and Japan.Summary Of Background DataAs clinical decision-making becomes more data driven, risk stratification will be crucial to minimize complications. Spine surgeons world-wide face this issue, leading to parallel efforts to address risk stratification. This raises the question as to whether pooled data would be valuable and whether models generated in one country would be applicable to other populations.MethodsPredictors of SSI and 30-day readmission from 3 prospective databases (N2QOD N = 2653, DaneSpine N = 1993, JAMSD N = 3798) were determined and compared to identify common or divergent predictive risks.ResultsPredictive variables differed in the 3 databases, for both readmission and SSI. Factors predictive for hospital readmission were ASA grade in N2QOD, (p = 0.013, OR 2.08), fusion levels in DaneSpine (p = 0.005, OR 1.67) and gender in JAMSD (p = 0.001, OR = 2.81). Associated differences in demographics and procedural factors included mean ASA grade (N2QOD = 2.45, JAMSD = 1.72) and fusion levels (N2QOD = 1.39, DaneSpine = 1.52, JAMSD = 1.34). For SSI, gender (p = 0.000, OR = 3.30), diabetes (p = 0.000, OR = 2.90) and Length of Stay (p = 0.000, OR = 1.02) were predictive in JAMSD. No predictors were identified in N2QOD or DaneSpine.ConclusionsPredictors of SSI and hospital readmission differ in the US, Denmark and Japan, suggesting that risk stratification models may need to be population specific or adjusted. Some differences in measured parameters exist in the 3 databases analyzed, however, patient and procedure selection also appear to differ and may limit the ability to directly pool data from different regions. Therefore, risk stratification models developed in one country may not be directly applicable to other countries.Level Of Evidence2.

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