• Neurosurgery · Sep 2020

    Cost of Readmissions Following Anterior Cervical Discectomy and Fusion: Insights from the Nationwide Readmissions Database.

    • Anshit Goyal, Archis R Bhandarkar, Mohammed Ali Alvi, Panagiotis Kerezoudis, Yagiz U Yolcu, Elizabeth B Habermann, Arjun S Sebastian, and Mohamad Bydon.
    • Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.
    • Neurosurgery. 2020 Sep 15; 87 (4): 679-688.

    BackgroundPostoperative readmissions are a significant driver of variation in bundled care costs associated with cervical spine surgery.ObjectiveTo determine the factors predicting the cost of readmission episodes following elective anterior cervical discectomy and fusion (ACDF).MethodsWe queried the Healthcare Cost and Utilization Project Nationwide Readmissions Database for patients undergoing elective ACDF during 2012 to 2015. Multivariable linear regression was performed to establish the factors associated with the cost of each 30-/90-d readmission episode.ResultsA total of 139 877 and 113 418 patients met inclusion criteria for the evaluation of 30- and 90-d readmissions, respectively. Among these, the national rates of 30- and 90-d readmission after an elective ACDF were 3% and 6%, respectively. The median cost of a 30- and 90-d readmission episode was $6727 (IQR: $3844-$13 529) and $8507 (IQR: $4567-$17 460), respectively. Relative predictor importance analysis revealed that the number of procedures at index admission (IA), length of stay at IA, and time elapsed between index surgical admission and readmission were the top predictors of both 30- and 90-d readmission costs (all P < .001). Although cervical myelopathy accounted for only 3.6% of all 30-d readmissions, it accounted for the largest share (8%) of 30-d readmission costs.ConclusionIn this analysis from a national all-payer database, we determined the factors associated with the cost of readmissions following elective ACDF. These results are important in assisting policymakers and payers with a better risk adjustment in bundled care payment systems and for surgeons in implementing readmission cost-reduction efforts.Copyright © 2019 by the Congress of Neurological Surgeons.

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