Risk Factors for 30-Day Readmissions and Reoperations After 3-Column Osteotomy for Spinal Deformity

Rafael De la Garza Ramos, Jonathan Nakhla, Murray Echt, Yaroslav Gelfand, Aleka N. Scoco, Merritt D. Kinon, Reza Yassari

Research output: Contribution to journalArticle

Abstract

Study Design: Retrospective study of a prospectively collected database. Objective: To investigate the rate and risk factors for 30-day readmissions and reoperations after 3-column osteotomy (3CO). Methods: The American College of Surgeons National Surgical Quality Improvement Program database (2012-2014) was reviewed. Inclusion criteria were adult patients who underwent 3CO. The rate of 30-day readmission/reoperation was examined, and the association between patient/operative characteristics and outcome was investigated via multivariate analysis. Results: There were 299 patients who underwent a 3CO for spinal deformity. The rate of 30-day readmission and reoperation was 11.0% and 8.4%, respectively; 7.7% of readmissions were related to the primary procedure and 3.3% were unrelated. The most common unique cause for readmission was wound infection in 27.2% of cases. Among reoperations, the most common unique indications were wound infection (20.0%) and implant-related complications (20.0%). On multivariate analysis, obesity (odds ratio [OR] = 2.96; 95% CI = 1.06-8.25; P =.038), chronic obstructive pulmonary disease (OR = 20.8; 95% CI = 3.49-123.5; P =.001), and fusion of 13 or more spinal levels were independent predictors of readmission (OR = 4.86; 95% CI = 1.21-19.5; P =.025). On the other hand, independent predictors of reoperation included chronic obstructive pulmonary disease (OR = 6.33; 95% CI = 1.16-34.5; P =.033) and chronic steroid use (OR = 6.69; 95% CI = 1.61-27.7; P =.009). Conclusion: Wound complications and short-term implant-related complications are important causes of readmission and/or reoperation after 3CO. Preoperative factors such as obesity, chronic lung disease, chronic steroid use, and long-segment fusion procedures may significantly increase the risk of 30-day morbidity following high-grade osteotomies.

Original languageEnglish (US)
Pages (from-to)483-489
Number of pages7
JournalGlobal Spine Journal
Volume8
Issue number5
DOIs
StatePublished - Aug 1 2018

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Osteotomy
Reoperation
Spine
Odds Ratio
Wound Infection
Chronic Obstructive Pulmonary Disease
Multivariate Analysis
Obesity
Steroids
Databases
Quality Improvement
Lung Diseases
Chronic Disease
Retrospective Studies
Morbidity
Wounds and Injuries

Keywords

  • NSQIP
  • readmission
  • reoperation
  • spinal deformity
  • three-column osteotomy

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Risk Factors for 30-Day Readmissions and Reoperations After 3-Column Osteotomy for Spinal Deformity. / De la Garza Ramos, Rafael; Nakhla, Jonathan; Echt, Murray; Gelfand, Yaroslav; Scoco, Aleka N.; Kinon, Merritt D.; Yassari, Reza.

In: Global Spine Journal, Vol. 8, No. 5, 01.08.2018, p. 483-489.

Research output: Contribution to journalArticle

De la Garza Ramos, Rafael ; Nakhla, Jonathan ; Echt, Murray ; Gelfand, Yaroslav ; Scoco, Aleka N. ; Kinon, Merritt D. ; Yassari, Reza. / Risk Factors for 30-Day Readmissions and Reoperations After 3-Column Osteotomy for Spinal Deformity. In: Global Spine Journal. 2018 ; Vol. 8, No. 5. pp. 483-489.
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abstract = "Study Design: Retrospective study of a prospectively collected database. Objective: To investigate the rate and risk factors for 30-day readmissions and reoperations after 3-column osteotomy (3CO). Methods: The American College of Surgeons National Surgical Quality Improvement Program database (2012-2014) was reviewed. Inclusion criteria were adult patients who underwent 3CO. The rate of 30-day readmission/reoperation was examined, and the association between patient/operative characteristics and outcome was investigated via multivariate analysis. Results: There were 299 patients who underwent a 3CO for spinal deformity. The rate of 30-day readmission and reoperation was 11.0{\%} and 8.4{\%}, respectively; 7.7{\%} of readmissions were related to the primary procedure and 3.3{\%} were unrelated. The most common unique cause for readmission was wound infection in 27.2{\%} of cases. Among reoperations, the most common unique indications were wound infection (20.0{\%}) and implant-related complications (20.0{\%}). On multivariate analysis, obesity (odds ratio [OR] = 2.96; 95{\%} CI = 1.06-8.25; P =.038), chronic obstructive pulmonary disease (OR = 20.8; 95{\%} CI = 3.49-123.5; P =.001), and fusion of 13 or more spinal levels were independent predictors of readmission (OR = 4.86; 95{\%} CI = 1.21-19.5; P =.025). On the other hand, independent predictors of reoperation included chronic obstructive pulmonary disease (OR = 6.33; 95{\%} CI = 1.16-34.5; P =.033) and chronic steroid use (OR = 6.69; 95{\%} CI = 1.61-27.7; P =.009). Conclusion: Wound complications and short-term implant-related complications are important causes of readmission and/or reoperation after 3CO. Preoperative factors such as obesity, chronic lung disease, chronic steroid use, and long-segment fusion procedures may significantly increase the risk of 30-day morbidity following high-grade osteotomies.",
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AU - De la Garza Ramos, Rafael

AU - Nakhla, Jonathan

AU - Echt, Murray

AU - Gelfand, Yaroslav

AU - Scoco, Aleka N.

AU - Kinon, Merritt D.

AU - Yassari, Reza

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N2 - Study Design: Retrospective study of a prospectively collected database. Objective: To investigate the rate and risk factors for 30-day readmissions and reoperations after 3-column osteotomy (3CO). Methods: The American College of Surgeons National Surgical Quality Improvement Program database (2012-2014) was reviewed. Inclusion criteria were adult patients who underwent 3CO. The rate of 30-day readmission/reoperation was examined, and the association between patient/operative characteristics and outcome was investigated via multivariate analysis. Results: There were 299 patients who underwent a 3CO for spinal deformity. The rate of 30-day readmission and reoperation was 11.0% and 8.4%, respectively; 7.7% of readmissions were related to the primary procedure and 3.3% were unrelated. The most common unique cause for readmission was wound infection in 27.2% of cases. Among reoperations, the most common unique indications were wound infection (20.0%) and implant-related complications (20.0%). On multivariate analysis, obesity (odds ratio [OR] = 2.96; 95% CI = 1.06-8.25; P =.038), chronic obstructive pulmonary disease (OR = 20.8; 95% CI = 3.49-123.5; P =.001), and fusion of 13 or more spinal levels were independent predictors of readmission (OR = 4.86; 95% CI = 1.21-19.5; P =.025). On the other hand, independent predictors of reoperation included chronic obstructive pulmonary disease (OR = 6.33; 95% CI = 1.16-34.5; P =.033) and chronic steroid use (OR = 6.69; 95% CI = 1.61-27.7; P =.009). Conclusion: Wound complications and short-term implant-related complications are important causes of readmission and/or reoperation after 3CO. Preoperative factors such as obesity, chronic lung disease, chronic steroid use, and long-segment fusion procedures may significantly increase the risk of 30-day morbidity following high-grade osteotomies.

AB - Study Design: Retrospective study of a prospectively collected database. Objective: To investigate the rate and risk factors for 30-day readmissions and reoperations after 3-column osteotomy (3CO). Methods: The American College of Surgeons National Surgical Quality Improvement Program database (2012-2014) was reviewed. Inclusion criteria were adult patients who underwent 3CO. The rate of 30-day readmission/reoperation was examined, and the association between patient/operative characteristics and outcome was investigated via multivariate analysis. Results: There were 299 patients who underwent a 3CO for spinal deformity. The rate of 30-day readmission and reoperation was 11.0% and 8.4%, respectively; 7.7% of readmissions were related to the primary procedure and 3.3% were unrelated. The most common unique cause for readmission was wound infection in 27.2% of cases. Among reoperations, the most common unique indications were wound infection (20.0%) and implant-related complications (20.0%). On multivariate analysis, obesity (odds ratio [OR] = 2.96; 95% CI = 1.06-8.25; P =.038), chronic obstructive pulmonary disease (OR = 20.8; 95% CI = 3.49-123.5; P =.001), and fusion of 13 or more spinal levels were independent predictors of readmission (OR = 4.86; 95% CI = 1.21-19.5; P =.025). On the other hand, independent predictors of reoperation included chronic obstructive pulmonary disease (OR = 6.33; 95% CI = 1.16-34.5; P =.033) and chronic steroid use (OR = 6.69; 95% CI = 1.61-27.7; P =.009). Conclusion: Wound complications and short-term implant-related complications are important causes of readmission and/or reoperation after 3CO. Preoperative factors such as obesity, chronic lung disease, chronic steroid use, and long-segment fusion procedures may significantly increase the risk of 30-day morbidity following high-grade osteotomies.

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