A multifactorial investigation of 90-day readmission risk in thoracolumbar burst fractures: Does surgery play a role?

BACKGROUND

Most spinal fractures occur in the thoracolumbar region, with controversy persisting over operative versus nonoperative treatment paradigms for neurologically intact thoracolumbar burst fractures (TLBF). This study sought to determine the readmission rate, risk factors, and total hospital charges within 90 days of TLBF.

METHODS

Using International Classification of Diseases, Tenth Revision (ICD-10) codes, we retrospectively reviewed all adult patients in the 2018 United States Healthcare Utilization Project Nationwide Readmissions Database with a new single-level TLBF from January to September 2018. We assessed readmissions, operative versus nonoperative treatment, demographics, comorbidities, charges, and payer status.

RESULTS

We identified 4,395 TLBF patients, with 1,857 (42%) treated operatively and 2,538 (58%) treated nonoperatively. There was a 7.0% unplanned 90-day readmission rate in the overall cohort. For readmitted patients, 69 (22.5%) were treated operatively, and 238 (77.5%) were treated nonoperatively. Patients treated operatively were less likely to undergo readmission (adjusted odds ratios [aOR]=0.39, 95% confidence interval [CI]=0.29-0.53, p<.001), though operative management was associated with substantial charges (mean $161,728, 95% CI $153,720-$169,735, p<.001). Total hospital charges were significantly greater in readmitted patients ($224,445±$184,681) than in nonreadmitted patients ($131,783±$148,029, p<.001). Patients with obesity (p<.0001, aOR=2.04, 95% CI=1.5-2.8), coagulopathy (p=.05), pain syndromes (p<.01), and/or bipolar disorder (p<.01) were significantly more likely to be readmitted, as were patients with Medicare when compared to those with Medicaid, private insurance, or self-pay (p<.01). Operatively treated patients with nutritional deficiencies demonstrated the highest odds for readmission (aOR=3.5, 95% CI=1.41-8.8, p<.01), suggesting surgical caution for these patients.

CONCLUSIONS

We observed a 7.0% 90-day readmission rate for neurologically intact TLBF patients with key comorbidities associated with increased risk. Recognition of these comorbidities may aid clinicians in counseling patients and considering operative versus nonoperative management of neurologically intact TLBF.