Predictors of Readmission, Reoperation, and Complications After Spine Surgery

Introduction: Readmission and reoperation are used as hospital and surgeon quality metrics. Venous thromboembolic events (VTE), including both deep venous thrombosis (DVT) and pulmonary embolism (PE), are a major cause of readmission, morbidity, mortality, after spine surgery. Specific procedural, perioperative, and patient characteristics may be associated with these outcomes. Methods: We retrospectively examined records from 6870 consecutive spine surgeries at our institution. We collected data on patient demographics, surgery, hospital course, and 30-day rates of VTE, readmission, reoperation, and epidural hematoma requiring evacuation. Stepwise multivariable logistic regression was used to identify independent predictors of each outcome. Results: Factors associated with VTE within 30 days of surgery include a history of VTE (OR 3.92 [1.83, 8.36], p < 0.001), EBL (OR 1.00 [1.00, 1.00], p = 0.004), fracture (OR 5.42 [2.09, 14.05], p = 0.001), history of PE (OR 4.04 [1.22, 13.42], p = 0.023), and transfusion (OR 2.26 [1.07, 4.77], p = 0.033). Factors associated with readmission were a history of PE (OR 3.27 [1.07, 9.97], p = 0.038), PE within 30 days (OR 8.07 [2.26, 28.8], p = 0.001), transfusion (2.54 [1.55, 4.17], p < 0.001), comorbid disease burden (OR 1.35 {1.01, 1.80], p = 0.041), and tumor surgery (OR 2.84 [1.32, 6.10], p = 0.007). Factors associated with reoperation were EBL (OR 1.00 [1.00, 1.00], p = 0.008), transfusion (OR 3.86 [1.38, 10.79], p = 0.01), and PE within 30 days (OR 6.05 [1.03, 35.62], p = 0.046). Only transfusion was associated with epidural hematoma within 30 days (OR 7.38 [1.37, 39.83], p = 0.02). Conclusions: Transfusion and EBL are associated with numerous negative outcomes after spine surgery. Transfusion is an independent predictor of VTE, readmission, reoperation, and epidural hematoma requiring evacuation. Specific spinal pathologies were associated with specific negative outcomes.