• Spine J · Nov 2016

    Outpatient continuity of care and 30-day readmission after spine surgery.

    • Symeon Missios and Kimon Bekelis.
    • Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
    • Spine J. 2016 Nov 1; 16 (11): 1309-1314.

    Background ContextThe value of continuity of care in preventing 30-day readmissions after surgical procedures remains an issue of debate.PurposeThis study aimed to investigate the association of being evaluated in the emergency room (ER) of the hospital where the original procedure was performed with 30-day readmissions for spine surgery patients.Study Design/SettingThis is a cohort study.Patient SampleA total of 16,483 spine surgery patients were evaluated in the emergency department within 30-days postoperatively.Outcome MeasuresA 30-day post-discharge readmission was the outcome measure.MethodsWe performed a cohort study involving patients who were evaluated in the ER within 30-days after discharge following spine surgery from 2009 to 2013, and were registered in the Statewide Planning and Research Cooperative System database. A propensity score adjusted model was used to control for confounding.ResultsFrom our patients, 11,638 (70.6%) were seen in a hospital different from the one where the original procedure was performed (12.0% readmitted), and 4,845 (29.4%) were evaluated at the original hospital (10.9% readmitted). In a multivariable analysis, we demonstrated that being evaluated in the original hospital was associated with decreased rate of 30-day readmission (odds ratio [OR], 0.87; 95% confidence interval [CI], 0.77-0.97). We found similar associations in a propensity score adjusted model (OR, 0.87; 95% CI, 0.78-0.97). This corresponded to seven patients who needed to be evaluated in the hospital where the original procedure was performed to prevent one readmission.ConclusionsUsing a comprehensive all-payer cohort of patients in New York State, who were evaluated in the ER after spine surgery, we identified an association of assessment in the hospital where the original procedure was performed with lower rate of 30-day readmissions. This underscores the potential importance of continuity of care in readmission prevention for these patients.Copyright © 2016 Elsevier Inc. All rights reserved.

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