Abstract and Introduction
Abstract
Study Design. A retrospective cohort review.
Objective. The aim of this study is to investigate whether preoperative malnutrition is an independent risk factor for unplanned 30-day readmission after elective spine surgery.
Summary of Background Data. Thirty-day hospital readmission rate is being used as a proxy for quality of care. Accordingly, hospitals and health systems are investing considerable resources into the identification of patients at risk of hospital readmission and designing interventions to reduce the rate of hospital readmissions.
Methods. The medical records of 145 patients undergoing elective spine surgery at a major academic medical center were reviewed. Preoperative serum albumin level was assessed on all patients and used to quantify nutritional status. Albumin less than 3.5 g/dL was recognized malnourished. Patient demographics, comorbidities, and postoperative complication rates were collected. The association between preoperative serum albumin level and 30-day readmission rate was assessed via multivariate logistic regression analysis.
Results. Baseline characteristics were similar between both groups. Low albumin was found in 28% of patients in this study. Malnourished patients were more likely to experience a postoperative complication and a prolonged duration of hospital stay (3.80 vs. 8.67 days), P = 0.03. Overall, 14.48% of patients were readmitted within 30 days of discharge, with malnourished patients experiencing a three-fold increase in 30-day readmission rates (malnourished: 27.50% vs. nourished: 9.52%, P = 0.02). Binary logistic regression with and without propensity score adjustment for risk factors demonstrated that preoperative malnutrition (low serum albumin level) is an independent predictor of 30-day readmission after elective spine surgery (P = 0.01).
Conclusion. Pre-operative malnutrition is an independent risk factor for readmission within 30 days of discharge after elective spine surgery. Laboratory markers of nutrition can identify patients at risk of unplanned hospital readmission. This risk determination identifies a potentially modifiable risk factor for early readmission.
Level of Evidence: 3
Introduction
In the last decade, health care costs in the United States have been soaring at a disparaging rate. Hospital readmissions have contributed a large part to the increased costs, in particular 30-day readmission rates. The Centers for Medicare & Medicaid Services (CMS) estimates over $17 billion spent on hospital readmissions that could have been prevented.[1,3] In an effort to reduce readmission rates, the Hospital Readmissions Reductions Program (HRRP) has been implemented to increase hospital pressure to reduce their number of readmissions.[1,2] Under HRRP, CMS has approximated 80% of hospitals being penalized for high 30-day readmission rates.[1–3] Identifying risk factors of 30-day readmissions is essential to lessen the burden of high health care costs due to hospital readmissions.
Malnutrition has become a modifiable risk factor of interest, with the prevalence in medical inpatients being 20 to 45%.[4–8] Malnutrition is associated with a decreased immune response and cardiac function, as well as increased muscle wasting.[5,10] Although the role of malnutrition has been investigated in other nonsurgical cohorts, little is known about the role of malnutrition on 30-day unplanned readmission after elective spine surgery. In a study of 1683 hospital discharges of elderly patients (≥65 yrs of age), Robinson[4] demonstrated that low serum albumin (<3.5 g/dL) was an independent predictor of 30-day readmission after hospital discharge. Similarly, in a study of 818 hospitalized adult patients, Lim et al.[9] found that malnourished patients had longer hospital stays, increased cost of care, and a higher likelihood of being readmitted within 15 days. Furthermore, the authors demonstrated that malnutrition was a significant predictor of mortality.[9]
The aim of this study is to investigate whether preoperative malnutrition is an independent risk factor for unplanned 30-day readmission after elective spine surgery.
Spine. 2016;41(17):1400-1404. © 2016 Lippincott Williams & Wilkins
