Readmission after surgery is associated with negative outcomes for patients and hospitals. It is costly and is associated with inferior long-term clinical outcomes. Accordingly, reducing hospital readmission rates has garnered the attention of policy makers because it achieves the dual benefit of improving quality and reducing costs. In 2013, the Centers for Medicare & Medicaid Services (CMS) implemented the hospital readmission reduction policy that penalizes hospitals for “excessive” all-cause hospital readmissions within 30 days after discharge. This study investigated the influence of psychiatric comorbidities on 30-day all-cause readmissions following elective spine surgery. The authors hypothesized that patients with high baseline affective disorders are most likely to be readmitted within 30 days of discharge.
The medical records of 400 patients undergoing elective spine surgery at a major academic medical center were reviewed. Of the 400, comprehensive one- and two-year patient reported outcomes data was available for 107 patients. The authors identified all unplanned readmissions within 30 days of discharge. The prevalence of affective disorders, such as depression and anxiety, were also assessed. The authors had hypothesized that depression and anxiety are independently associated with an increased risk of 30-day readmission after elective spine surgery. All-cause readmissions within 30 days of discharge was the primary outcome variable.
The data indicated that baseline characteristics were similar between both groups. Approximately six percent of patients were readmitted within 30 days of discharge. The rate of readmission was three-fold greater for individuals with a psychiatric comorbidity compared with those without a psychiatric comorbidity. In a univariate analysis, race, BMI, gender, patient age, smoking, diabetes and fusion levels were associated with increased 30-day readmission rates. However, in a multivariate logistic regression model, depression was an independent predictor of readmission within 30 days of discharge. Additionally, there were no significant differences in baseline, one- and two-year patient reported outcomes measures between both groups.
Psychological disorders, such as depression and anxiety, are independently associated with higher all cause 30-day readmission rates after elective spine surgery. The study concluded that mental health components should be added to future interventions to reduce readmission.
Author Block: Owoicho Adogwa, MD; Aladine Elsamadicy, BE; Joseph Cheng, MD, MS; Carlos Bagley, MD (Durham, N.C.)
Disclosure: The author reported no conflicts of interest.
Media Representatives: The 2016 AANS Annual Scientific Meeting press section will include releases on highlighted scientific research, AANS officers and award winners, Neurosurgery Awareness Month and other relevant information about the 2016 program. Releases will be posted under the “Media” area on the 2016 AANS Annual Scientific Meeting website. If you have interest in a topic related to neurosurgery or would like to interview a neurosurgeon — either onsite or via telephone — during the event, please contact Alice Kelsey, AANS associate executive director, via email at [email protected].
About the 2016 AANS Annual Scientific Meeting: Attended by neurosurgeons, neurosurgical residents, medical students, neuroscience nurses, clinical specialists, physician assistants, allied health professionals and other medical professionals, the AANS Annual Scientific Meeting is the largest gathering of neurosurgeons in the nation, with an emphasis on the field’s latest research and technological advances. More than 1,200 scientific abstracts were submitted for the 2015 AANS Annual Scientific Meeting; the scientific presentations accepted for the 2016 event will represent cutting-edge examples of the incredible developments taking place within the field of neurosurgery. Additional information about the 2016 AANS Annual Scientific Meeting and the meeting program can be found here.
Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 10,000 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. Fellows of the AANS are board-certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons of Canada or the Mexican Council of Neurological Surgery, A.C. Neurosurgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the spinal column, spinal cord, brain, nervous system and peripheral nerves.
For more information, visit www.AANS.org.
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