Abstract and Introduction
Abstract
Study Design. Retrospective cohort review.
Objective. The aim of this study is to investigate whether patient race is an independent predictor of unplanned 30-day hospital readmission after elective spine surgery.
Summary of Background Data. Racial disparities are known to exist for many aspects of surgical care. However, it is unknown if disparities exist in 30-day readmissions after elective spine surgery, an area that is becoming a prime focus for clinical leaders and policymakers.
Methods. Records of 600 patients undergoing elective spine surgery at a major academic medical center were reviewed. We identified all unplanned readmissions within 30 days of discharge. Unplanned readmissions were defined to have occurred as a result of either a surgical or a nonsurgical complication. Patient's records were reviewed to determine the cause of readmission and the length of hospital stay. The main outcome measure was risk-adjusted odds of all-cause 30-day readmission. We used multivariate logistic regression to determine if Black patients had an increased likelihood of 30-day readmission compared with White patients.
Results. Baseline characteristics were similar between both groups. Black patients had higher readmission rates than White patients (10.56% vs. 7.86%, P = 0.04). In a univariate analysis, race, body mass index, sex, patient age, smoking, diabetes, and fusion levels were associated with increased 30-day readmission rates. However, in a multivariate logistic regression model, race was an independent predictor of 30-day readmission after elective spine surgery. In addition, no significant differences in baseline, 1-year and 2-year patient reported outcomes measures were observed between both groups.
Conclusion. This study suggests that Black patients are more likely to be readmitted within 30-days of discharge after elective spine surgery. Efforts at reducing disparities should focus not only on race-based measures but also effective post discharge care.
Level of Evidence: 3
Introduction
Racial disparities in healthcare affect patients significantly in both cost and quality of care. Bridging the gap of hospital care between Black and White patients continues to be a priority of national policy makers. One primary concern of having disproportionate hospital care is having a disproportionate 30-day readmission rate among patient populations. The Hospital Readmissions Reductions Program (HRRP) has become a national movement to reduce the number and soaring healthcare costs of hospital readmissions.[1] The Centers for Medicare and Medicaid Services (CMS) estimates $17 billion in avoidable readmissions, with approximately 80% of hospitals being penalized for high rates of 30-day readmissions.[1–3] Given the costs associated with increasing readmission rates, understanding the disparities in hospital care and the drivers of unplanned readmissions in is imperative to addressing this problem.
Previous studies have attempted to associate health care disparities and readmission rates. In a study of 30-day readmission rates of Medicare beneficiaries, Joynt et al[4] demonstrated that Black patients overall have higher rate of 30-day readmissions than White patients. The authors found that patients from minority-serving hospitals also had higher readmission rates than those from nonminority serving hospitals. However, how patient race plays in unplanned 30-day hospital readmission remains unknown.
The aim of this study is to investigate whether patient race is an independent predictor of unplanned 30-day hospital readmission after elective spine surgery.
Spine. 2016;41(21):1677-1682. © 2016 Lippincott Williams & Wilkins
