Winner of the Robert Florin Resident Award, Owoicho Adogwa, MD, presented his research, Association Between Baseline Affective Disorders and 30-day Readmission Rates in Patients Undergoing Elective Spine Surgery, during the 2016 American Association of Neurological Surgeons (AANS) Annual Scientific Meeting.
Readmission after surgery is associated with negative outcomes for patients and hospitals. It is costly and is associated with inferior long-term clinical outcomes. Accordingly, reducing hospital readmission rates has garnered the attention of policy makers because it achieves the dual benefit of improving quality and reducing costs. In 2013, the Centers for Medicare & Medicaid Services (CMS) implemented the hospital readmission reduction policy that penalizes hospitals for "excessive" all-cause hospital readmissions within 30 days after discharge. This study investigated the influence of psychiatric comorbidities on 30-day all-cause readmissions following elective spine surgery. The authors hypothesized that patients with high baseline affective disorders are most likely to be readmitted within 30 days of discharge.
The medical records of 400 patients undergoing elective spine surgery at a major academic medical center were reviewed. Of the 400, comprehensive one- and two-year patient reported outcomes data was available for 107 patients. The authors identified all unplanned readmissions within 30 days of discharge. The prevalence of affective disorders, such as depression and anxiety, were also assessed. The authors had hypothesized that depression and anxiety are independently associated with an increased risk of 30-day readmission after elective spine surgery. All-cause readmissions within 30 days of discharge was the primary outcome variable.
The data indicated that baseline characteristics were similar between both groups. Approximately six percent of patients were readmitted within 30 days of discharge. The rate of readmission was three-fold greater for individuals with a psychiatric comorbidity compared with those without a psychiatric comorbidity. In a univariate analysis, race, BMI, gender, patient age, smoking, diabetes and fusion levels were associated with increased 30-day readmission rates. However, in a multivariate logistic regression model, depression was an independent predictor of readmission within 30 days of discharge. Additionally, there were no significant differences in baseline, one- and two-year patient reported outcomes measures between both groups.
Psychological disorders, such as depression and anxiety, are independently associated with higher all cause 30-day readmission rates after elective spine surgery. The study concluded that mental health components should be added to future interventions to reduce readmission.
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