Most 30-day Readmissions After Anterior Cervical Discectomy and Fusion Are Not Due to Surgical Site-Related Issues

Study design A retrospective study of patients undergoing anterior cervical discectomy and fusion (ACDF) in the prospective National Surgical Quality Improvement Program (NSQIP) database. Objective To determine the most common reasons for readmission within 30 days after elective ACDF. Summary of background data ACDF is a commonly performed surgery that is safe and effective for treating a variety of cervical spine pathologies. With new quality-based reimbursements tied to readmissions within 30 days of discharge, better understanding of the causes of readmissions is, however, needed. Methods Patients undergoing ACDF in the NSQIP database from 2012 to 2014 were reviewed. The overall rate of readmission and documented reasons for readmission were collected. Multivariate regression was then used to determine risk factors for readmissions. Results A total of 17,088 patients undergoing elective ACDF were identified. There were 545 (3.2%) readmissions within 30 postoperative days. Of the readmitted patients, 293 (53.8%) were readmitted for nonsurgical site-related reasons, with neuropsychiatric (n = 44), cardiovascular (n = 39), and pneumonia (n = 37) being the most common reasons. A total of 184 patients (33.8%) were readmitted for surgical site-related reasons, with surgical site infection (n = 42), hemorrhage/hematoma (n = 42), and dysphagia (n = 32) being the most common reasons. A total of 84 patients (15.6%) had undocumented reasons for readmission. In multivariate analysis, only older age and higher American Society of Anesthesiologists class were independently associated with readmissions. Conclusion Most readmissions after ACDF were due to nonsurgical site-related reasons, suggesting the importance of careful patient selection, aggressive preoperative medical optimization, and adequate postoperative management. Level of evidence 3.