Risk factors for 90-day readmission after single-level lumbar fusion for degenerative spondylolisthesis in older adults: A National Readmission Database Analysis, 2016–2020

Abstract

Background/aim

Degenerative spondylolisthesis (DS) is a spinal disorder prevalent in older adults, often requiring lumbar fusion surgery. Despite the benefits of surgery, older adult patients face an increased risk of complications and readmission. This study aimed to identify risk factors for 90-day readmission following single-level lumbar fusion for DS in older adult patients.

Methods

This retrospective cohort study included the data of patients aged ≥60 years who had undergone single-level lumbar fusion for DS extracted from the National Readmission Database (NRD) from 2016 to 2020. Multivariable logistic regression with backward selection was used to identify factors associated with 90-day readmission.

Results

Data of 32,894 older adult patients were analyzed (mean age 70 years, 65% female.) Significant predictors of readmission were age (adjusted odds ratio [aOR] = 1.02, 95% confidence interval [CI]: 1.01–1.03), having Medicare/Medicaid insurance (aOR = 1.35, 95% CI: 1.19–1.54), myocardial infarction (aOR = 1.41, 95% CI: 1.16–1.72), venous thromboembolism (aOR = 2.39, 95% CI: 1.44–3.98), bleeding (aOR = 2.63, 95% CI: 1.08–6.40), and longer hospital stay (aOR = 1.04, 95% CI: 1.03–1.06). Stratified by age ≥70 years, several different risk factors were identified between the age groups.

Conclusion

Risk factors influencing 90-day readmission following single-level lumbar fusion in older adults with DS include age, comorbidities, perioperative complications, insurance type, and hospital length of stay (LOS). Patient-centered (or customized) perioperative strategies and postoperative care may ultimately help to reduce readmission rates in this population.