Weekend Admission Increases Risk of Readmissions Following Elective Cervical Spinal Fusion

Renee Ren, Calista Dominy, Brian Bueno, Sara Pasik, Jonathan Markowitz, Brandon Yeshoua, Brian Cho, Varun Arvind, Aly A. Valliani, Jun Kim, Samuel Cho

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: The “weekend effect” occurs when patients cared for during weekends versus weekdays experience worse outcomes. But reasons for this effect are unclear, especially amongst patients undergoing elective cervical spinal fusion (ECSF). Our aim was to analyze whether index weekend admission affects 30-and 90-day readmission rates post-ECSF. Methods: All ECSF patients > 18 years were retrospectively identified from the 2016–2018 Healthcare Cost and Utilization Project Nationwide Readmissions Database (NRD), using unique patient linkage codes and International Classification of Diseases, Tenth Revision codes. Patient demographics, comorbidities, and outcomes were analyzed. Univariate lo-gistic regression analyzed primary outcomes of 30-and 90-day readmission rates in weekday or weekend groups. Multivariate regression determined the impact of complications on readmission rates. Results: Compared to the weekday group (n = 125, 590), the weekend group (n = 1, 026) held a higher percentage of Medicare/Medicaid insurance, incurred higher costs, had lon-ger length of stay, and fewer routine home discharge (all p < 0. 001). There was no differ-ence in comorbidity burden between weekend versus weekday admissions, as measured by the Elixhauser Comorbidity Index (p = 0. 527). Weekend admissions had higher 30-day (4. 30% vs. 7. 60%, p < 0. 001) and 90-day (7. 80% vs. 16. 10%, p < 0. 001) readmission rates, even after adjusting for sex, age, insurance status, and comorbidities. All-cause complica-tion rates were higher for weekend admissions (8. 62% vs. 12. 7%, p < 0. 001), specifically deep vein thrombosis, infection, neurological conditions, and pulmonary embolism. Conclusion: Index weekend admission increases 30-and 90-day readmission rates after ECSF. In patients undergoing ECSF on weekends, postoperative care for patients at risk for specific complications will allow for improved outcomes and health care utilization.

Original languageEnglish
Pages (from-to)290-300
Number of pages11
JournalNeurospine
Volume20
Issue number1
DOIs
StatePublished - Mar 2023

Keywords

  • Com-plications
  • Elective cervical spinal fusion
  • Perioperative characteristics
  • Postoperative outcomes
  • Readmission rates
  • Weekend admission

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