Unplanned Hospital Readmissions and Reoperations After Pediatric Spinal Fusion Surgery.

STUDY

DESIGN

Retrospective review.

OBJECTIVE

To investigate the rates and reasons for unplanned readmissions and reoperation after pediatric spinal fusion surgery at our institution and to identify risk factors by analyzing patient and surgical characteristics. Unplanned readmission and reoperation were defined as unplanned events within 90 days of the index surgery.

SUMMARY OF BACKGROUND DATA: The rate of unplanned readmission and reoperation after pediatric spinal fusion surgery is not well established.

METHODS

Clinical records were reviewed for all children who underwent spinal fusion surgical procedures for spinal deformity correction performed by 1 surgeon from 2000 through 2013 at our institution. Inclusion criteria were age of 10 to 18 years at surgery, fusion spanning more than 5 vertebral levels, and 3 months of clinical or radiographical follow-up (1002 patients met these criteria). Univariate and multivariate logistic regression models were created. Statistical significance was set at a P value of less than 0.05 for all analyses.

RESULTS

The overall 90-day unplanned readmission and reoperation rates were 8.0% and 3.8%, respectively. The most common causes of readmission were wound dehiscence (1.8%), deep wound infection (1.5%), pulmonary complications (1%), and superficial wound infection (0.9%). Univariate analysis showed that readmission was significantly associated with a higher number of levels fused, greater estimated blood loss, longer length of stay, and certain diagnoses; reoperation was significantly associated with a higher number of levels fused and certain diagnoses. On multivariate analysis, only patient diagnosis was found to be significantly associated with readmission and reoperation; patients with congenital scoliosis, genetic or syndromic scoliosis, cerebral palsy, and other neuromuscular disorders had significantly higher rates.

CONCLUSION

Unplanned readmission rate after pediatric spinal fusion surgery was 8%, most commonly for wound dehiscence and deep and superficial infections. Increased intraoperative blood loss, higher number of levels fused, and certain diagnoses are risk factors for unplanned readmission.

LEVEL OF EVIDENCE: 4.