The burden of medical and orthopedic readmissions following posterior spinal fusion for idiopathic adolescent scoliosis.

INTRODUCTION

Unplanned hospital readmissions remain one of the largest causes for increased episode of care and adverse events. These readmissions are especially significant in posterior spinal fusion (PSF) for idiopathic adolescent scoliosis (AIS). Therefore, this study aimed to 1) determine the overall 90-day PSF readmission rate; 2) report the timing of readmission post-discharge; and 3) identify the most frequent causes of 90-day readmissions (i.e., medical- or orthopedic-related).

METHODS

A cohort of 657 consecutive patients undergoing PSF for AIS between January 1, 2010 and February 28, 2021 were selected. Readmissions were examined manually for determination of primary cause and verification. Two-tailed t tests and chi-squared/Fisher tests were utilized with logistic regressions for individual variables.

RESULTS

The 90-day readmission rate was 6.24% or 41 patients with most of the readmissions being in the first 6 weeks with 3.5% medical and 2.74% orthopedic readmissions. Wound infections (44%), normal physiological events (27%), and postoperative pain (17%) were the three top orthopedic readmission causes while gastrointestinal (45%), pulmonary (13%), and neurologic (13%) causes were the top three medical reasons. There was no difference between the rates of ICU admission (p = 0.573) or length of readmission stay (p = 0.201). However, orthopedic readmissions were significantly more likely to be treated operatively (p < 0.001) and more likely to receive transfusions (p = 0.030). Regression analysis found that decreased length of stay (p = 0.031) and less levels fused (p = 0.039) were associated with decreased risks for readmission while age (p = 0.126), BMI (p = 0.312), race (p = 0.13), preoperative Cobb's Angle (p = 0.197), OR Time (p = 0.156), autograft use (p = 0.092, and sex (p = 0.271) had no effect.

CONCLUSION

Most readmissions after PSF for scoliosis occur in the first 6 weeks postoperative with wound infections and gastrointestinal issues being the leading factors for orthopedic and medical readmission respectively. Length of stay and number of levels fused were associated with risks for unplanned hospital readmissions within 90 days.