Risk factors of emergency department visits following elective cervical and lumbar surgical procedures: a multi-institution analysis from the Michigan Spine Surgery Improvement Collaborative

Author:

Ogunsola Oludotun1,Linzey Joseph R.1,Zaki Mark M.1,Chang Victor2,Schultz Lonni R.2,Springer Kylie2,Abdulhak Muwaffak2,Khalil Jad G.3,Schwalb Jason M.2,Aleem Ilyas4,Nerenz David R.2,Perez-Cruet Miguelangelo3,Easton Richard5,Soo Teck M.6,Tong Doris6,Park Paul7

Affiliation:

1. Departments of Neurosurgery and

2. Henry Ford Health System, Detroit, Michigan;

3. Beaumont Health System, Royal Oak, Michigan;

4. Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan;

5. Department of Orthopedics, William Beaumont Hospital, Troy, Michigan;

6. Division of Neurosurgery, Ascension Providence Hospital, Michigan State University, College of Human Medicine, Southfield, Michigan; and

7. University of Tennessee & Semmes Murphey Clinic, Memphis, Tennessee

Abstract

OBJECTIVE Emergency department visits 90 days after elective spinal surgery are relatively common, with rates ranging from 9% to 29%. Emergency visits are very costly, so their reduction is of importance. This study’s objective was to evaluate the reasons for emergency department visits and determine potentially modifiable risk factors. METHODS This study retrospectively reviewed data queried from the Michigan Spine Surgery Improvement Collaborative (MSSIC) registry from July 2020 to November 2021. MSSIC is a multicenter (28-hospital) registry of patients undergoing cervical and lumbar degenerative spinal surgery. Adult patients treated for elective cervical and/or lumbar spine surgery for degenerative pathology (spondylosis, intervertebral disc disease, low-grade spondylolisthesis) were included. Emergency department visits within 90 days of surgery (outcome measure) were analyzed utilizing univariate and multivariate regression analyses. RESULTS Of 16,224 patients, 2024 (12.5%) presented to the emergency department during the study period, most commonly for pain related to spinal surgery (31.5%), abdominal problems (15.8%), and pain unrelated to the spinal surgery (12.8%). On multivariate analysis, age (per 5-year increase) (relative risk [RR] 0.94, 95% CI 0.92–0.95), college education (RR 0.82, 95% CI 0.69–0.96), private insurance (RR 0.79, 95% CI 0.70–0.89), and preoperative ambulation status (RR 0.88, 95% CI 0.79–0.97) were associated with decreased emergency visits. Conversely, Black race (RR 1.30, 95% CI 1.13–1.51), current diabetes (RR 1.13, 95% CI 1.01–1.26), history of deep venous thromboembolism (RR 1.28, 95% CI 1.16–1.43), history of depression (RR 1.13, 95% CI 1.03–1.25), history of anxiety (RR 1.32, 95% CI 1.19–1.46), history of osteoporosis (RR 1.21, 95% CI 1.09–1.34), history of chronic obstructive pulmonary disease (RR 1.19, 95% CI 1.06–1.34), American Society of Anesthesiologists class > II (RR 1.18, 95% CI 1.08–1.29), and length of stay > 3 days (RR 1.29, 95% CI 1.16–1.44) were associated with increased emergency visits. CONCLUSIONS The most common reasons for emergency department visits were surgical pain, abdominal dysfunction, and pain unrelated to index spinal surgery. Increased focus on postoperative pain management and bowel regimen can potentially reduce emergency visits. The risks of diabetes, history of osteoporosis, depression, and anxiety are areas for additional preoperative screening.

Publisher

Journal of Neurosurgery Publishing Group (JNSPG)

Reference22 articles.

1. Use of hospital-based acute care among patients recently discharged from the hospital;Vashi AA,2013

2. Emergency department visits after hospital discharge: a missing part of the equation;Rising KL,2013

3. Outpatient spine clinic utilization is associated with reduced emergency department visits following spine surgery;Pak LM,2018

4. 30-day emergency department visits after primary lumbar fusion: incidence, causes, risk factors, and costs;Jain N,2019

5. Patient factors affecting emergency department utilization and hospital readmission rates after primary anterior cervical discectomy and fusion: a review of 41,813 cases;Sheha ED,2019

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