Rates and risk factors associated with unplanned hospital readmission after fusion for pediatric spinal deformity.

BACKGROUND CONTEXT Short-term readmission rates are becoming widely used as a quality and performance metric for hospitals. Data on unplanned short-term readmission after spine fusion for deformity in pediatric patients are limited. PURPOSE To characterize the rate and risk factors for short-term readmission after spine fusion for deformity in pediatric patients. STUDY DESIGN This is a retrospective cohort study. PATIENT SAMPLE Data were obtained from the State Inpatient Database from New York, Utah, Nebraska, Florida, North Carolina (years 2006-2010), and California (years 2006-2011). OUTCOME MEASURES Outcome measures included 30- and 90-day readmission rates. MATERIALS AND METHODS Inclusion criteria were patients aged 0-21 years, a primary diagnosis of spine deformity, and a primary 3+-level lumbar or thoracic fusion. Exclusion criteria included revision surgery at index admission and cervical fusion. Readmission rates were calculated and logistic analyses were used to identify independent predictors of readmission. RESULTS There were a total of 13,287 patients with a median age of 14 years. Sixty-seven percent were girls. The overall 30- and 90-day readmission rates were 4.7% and 6.1%. The most common reasons for readmission were infection (38% at 30 days and 33% at 90 days), wound dehiscence (19% and 17%), and pulmonary complications (12% and 13%). On multivariate analysis, predictors of 30-day readmission included male sex (p=.008), neuromuscular (p<.0001) or congenital scoliosis (p=.006), Scheuermann kyphosis (p=.003), Medicaid insurance (p<.0001), length of stay of ≤3 days or ≥6 days (p<.0001), and surgery at a teaching hospital (p=.011). Surgery at a hospital performing >80 operations/year was associated with a 34% reduced risk of 30-day readmission (95% confidence interval 12%-50%, p=.005) compared with hospitals performing <20 operations/year. CONCLUSIONS The short-term readmission rate for pediatric spine deformity surgery is driven by patient-related factors, as well as several risk factors that may be modified to reduce this rate.