1329. Predictors of 90-day readmission in children undergoing spinal cord tumor surgery: a Nationwide Readmissions Database analysis

Authors: Muhammad Burhan Ud Din Janjua, MD; Sumanth Reddy; William Welch, MD; Amer Samdani, MD; Ali Ozturk, MD; Steven Hwang, MD; Bradley Weprin, MD; Dale Swift, MD (Dallas, TX)

Introduction:
Hospital readmissions are burdensome to healthcare providers as well as to the hospital system. 30-day readmissions are an important healthcare metric to assess outcomes. The 90-day readmission rate may better define factors contributing to readmissions among pediatric patients undergoing spinal tumor resection.

Methods:
The Nationwide Readmissions Database (NRD) was utilized to study demographics, comorbidities, admissions, hospital course, tumor behavior (malignant vs. benign), complications, and surgical revisions. Other variables included, All Patients Refined – Diagnosis Related Group (APR-DRG) risk of mortality and severity of illness scores during admission. The primary outcome variables of interest were 30-day and 90-day readmission rates.

Results:
Of 397 patients in 30-day readmission cohort, 43 (10.8%) were readmitted. Patients aged 16-20 comprised largest subgroup, however, highest readmission rate was observed among patients younger than age 5 (21.7%). Medicaid patients were three times more likely to be readmitted than private insurance (OR = 3.3, p < 0.001). Patients with benign tumors were less readmitted than with malignant tumors (OR = 0.36, p < 0.02). Of 377, 52 patients (16.0%) were readmitted within 90-day cohort. On average, patients were readmitted 26.4 days following the initial discharge (versus 10.6 in the 30-day cohort). Patients were readmitted for spinal procedures (13.3%), including fusions, revisions, and stimulator placement, while 16.8% of patients for chemotherapy, and 12.4% of patients were readmitted due to infections/septicemia. The median charges for each readmission approximated $50,000 and $40,000 for the 30- and 90-day readmission cohorts, respectively. 

Conclusion:
Unplanned hospital readmissions and associated charges after resection of spinal tumors remained high. Younger age, insurance through Medicaid, malignant behavior, and complications during initial admission were studied significant predictors during 30 and 90 days for the readmission. On average, patients were readmitted 15.8 days late following initial discharge, and readmitted 2.2 times during the 90-day vs. 30 day window.