Affiliation:
1. Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia;
2. McKenna EpiLog Fellowship in Population Health, University of Pennsylvania, Philadelphia; and
3. The West Chester Statistical Institute and Department of Mathematics, West Chester University, West Chester, Pennsylvania
Abstract
OBJECTIVE
Spinal fusion is one of the most common neurosurgical procedures. The LACE (length of stay, acuity of admission, Charlson Comorbidity Index [CCI] score, and emergency department [ED] visits within the previous 6 months) index was developed to predict readmission but has not been tested in a large, homogeneous spinal fusion population. The present study evaluated use of the LACE+ score for outcome prediction after lumbar fusion.
METHODS
LACE+ scores were calculated for all patients (n = 1598) with complete information who underwent single-level, posterior-only lumbar fusion at a single university medical system. Logistic regression was performed to assess the ability of the LACE+ score as a continuous variable to predict hospital readmissions within 30 days (30D), 30–90 days (30–90D), and 90 days (90D) of the index operation. Secondary outcome measures included ED visits and reoperations. Subsequently, patients with LACE+ scores in the bottom decile were exact matched to the patients with scores in the top 4 deciles to control for sociodemographic and procedural variables.
RESULTS
Among all patients, increased LACE+ score significantly predicted higher rates of readmissions in the 30D (p < 0.001), 30–90D (p = 0.001), and 90D (p < 0.001) postoperative windows. LACE+ score also predicted risk of ED visits at all 3 time points and reoperations at 30–90D and 90D. When patients with LACE+ scores in the bottom decile were compared with patients with scores in the top 4 deciles, higher LACE+ score predicted higher risk of readmissions at 30D (p = 0.009) and 90D (p = 0.005). No significant difference in hospital readmissions was observed between the exact-matched cohorts.
CONCLUSIONS
The present results suggest that the LACE+ score demonstrates utility in predicting readmissions within 30 and 90 days after single-level lumbar fusion. Future research is warranted that utilizes the LACE+ index to identify strategies to support high-risk patients in a prospective population.
Publisher
Journal of Neurosurgery Publishing Group (JNSPG)
Reference54 articles.
1. The LACE+ index as a predictor of 30-day patient outcomes in a urologic surgery population: a coarsened exact match study;Glauser;Urology,2019
2. LACE+ index: extension of a validated index to predict early death or urgent readmission after hospital discharge using administrative data;van Walraven;Open Med,2012
3. Of 20,376 lumbar discectomies, 2.6% of patients readmitted within 30 days: surgical site infection, pain, and thromboembolic events are the most common reasons for readmission;Webb,2017
4. Validation of the LACE index (Length of stay, Acuity of admission, Comorbidities, Emergency department use) in the adult neurosurgical patient population;Linzey;Neurosurgery,2020
5. Of 20,376 lumbar discectomies, 2.6% of patients readmitted within 30 days: surgical site infection, pain, and thromboembolic events are the most common reasons for readmission;Webb,2017
Cited by
3 articles.
订阅此论文施引文献
订阅此论文施引文献，注册后可以免费订阅5篇论文的施引文献，订阅后可以查看论文全部施引文献