Preoperative Nutritional Status is an Independent Predictor of 30-day Hospital Readmission after Elective Spine Surgery

Owoicho Adogwa, Aladine A. Elsamadicy, Ankit I. Mehta, Joseph Cheng, Carlos A. Bagley, Isaac O. Karikari

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Study Design. A retrospective cohort review. Objective. The aim of this study is to investigate whether preoperative malnutrition is an independent risk factor for unplanned 30-day readmission after elective spine surgery. Summary of Background Data. Thirty-day hospital readmission rate is being used as a proxy for quality of care. Accordingly, hospitals and health systems are investing considerable resources into the identification of patients at risk of hospital readmission and designing interventions to reduce the rate of hospital readmissions. Methods. The medical records of 145 patients undergoing elective spine surgery at a major academic medical center were reviewed. Preoperative serum albumin level was assessed on all patients and used to quantify nutritional status. Albumin less than 3.5 g/dL was recognized malnourished. Patient demographics, comorbidities, and postoperative complication rates were collected. The association between preoperative serum albumin level and 30-day readmission rate was assessed via multivariate logistic regression analysis. Results. Baseline characteristics were similar between both groups. Low albumin was found in 28% of patients in this study. Malnourished patients were more likely to experience a postoperative complication and a prolonged duration of hospital stay (3.80 vs. 8.67 days), P = 0.03. Overall, 14.48% of patients were readmitted within 30 days of discharge, with malnourished patients experiencing a three-fold increase in 30-day readmission rates (malnourished: 27.50% vs. nourished: 9.52%, P = 0.02). Binary logistic regression with and without propensity score adjustment for risk factors demonstrated that preoperative malnutrition (low serum albumin level) is an independent predictor of 30-day readmission after elective spine surgery (P = 0.01). Conclusion. Pre-operative malnutrition is an independent risk factor for readmission within 30 days of discharge after elective spine surgery. Laboratory markers of nutrition can identify patients at risk of unplanned hospital readmission. This risk determination identifies a potentially modifiable risk factor for early readmission. Level of Evidence: 3

Original languageEnglish (US)
Pages (from-to)1400-1404
Number of pages5
JournalSpine
Volume41
Issue number17
DOIs
StatePublished - Sep 1 2016

Fingerprint

Patient Readmission
Nutritional Status
Spine
Serum Albumin
Malnutrition
Albumins
Logistic Models
Propensity Score
Quality of Health Care
Proxy
Medical Records
Comorbidity
Length of Stay
Biomarkers
Regression Analysis
Demography

Keywords

  • 30-day readmission
  • albumin
  • hospital readmission
  • hypoalbuminemia
  • independent predictor
  • independent risk factor
  • malnutrition
  • preoperative nutritional status
  • spine
  • surgery

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Preoperative Nutritional Status is an Independent Predictor of 30-day Hospital Readmission after Elective Spine Surgery. / Adogwa, Owoicho; Elsamadicy, Aladine A.; Mehta, Ankit I.; Cheng, Joseph; Bagley, Carlos A.; Karikari, Isaac O.

In: Spine, Vol. 41, No. 17, 01.09.2016, p. 1400-1404.

Research output: Contribution to journalArticle

Adogwa, Owoicho ; Elsamadicy, Aladine A. ; Mehta, Ankit I. ; Cheng, Joseph ; Bagley, Carlos A. ; Karikari, Isaac O. / Preoperative Nutritional Status is an Independent Predictor of 30-day Hospital Readmission after Elective Spine Surgery. In: Spine. 2016 ; Vol. 41, No. 17. pp. 1400-1404.
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abstract = "Study Design. A retrospective cohort review. Objective. The aim of this study is to investigate whether preoperative malnutrition is an independent risk factor for unplanned 30-day readmission after elective spine surgery. Summary of Background Data. Thirty-day hospital readmission rate is being used as a proxy for quality of care. Accordingly, hospitals and health systems are investing considerable resources into the identification of patients at risk of hospital readmission and designing interventions to reduce the rate of hospital readmissions. Methods. The medical records of 145 patients undergoing elective spine surgery at a major academic medical center were reviewed. Preoperative serum albumin level was assessed on all patients and used to quantify nutritional status. Albumin less than 3.5 g/dL was recognized malnourished. Patient demographics, comorbidities, and postoperative complication rates were collected. The association between preoperative serum albumin level and 30-day readmission rate was assessed via multivariate logistic regression analysis. Results. Baseline characteristics were similar between both groups. Low albumin was found in 28{\%} of patients in this study. Malnourished patients were more likely to experience a postoperative complication and a prolonged duration of hospital stay (3.80 vs. 8.67 days), P = 0.03. Overall, 14.48{\%} of patients were readmitted within 30 days of discharge, with malnourished patients experiencing a three-fold increase in 30-day readmission rates (malnourished: 27.50{\%} vs. nourished: 9.52{\%}, P = 0.02). Binary logistic regression with and without propensity score adjustment for risk factors demonstrated that preoperative malnutrition (low serum albumin level) is an independent predictor of 30-day readmission after elective spine surgery (P = 0.01). Conclusion. Pre-operative malnutrition is an independent risk factor for readmission within 30 days of discharge after elective spine surgery. Laboratory markers of nutrition can identify patients at risk of unplanned hospital readmission. This risk determination identifies a potentially modifiable risk factor for early readmission. Level of Evidence: 3",
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AU - Adogwa, Owoicho

AU - Elsamadicy, Aladine A.

AU - Mehta, Ankit I.

AU - Cheng, Joseph

AU - Bagley, Carlos A.

AU - Karikari, Isaac O.

PY - 2016/9/1

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N2 - Study Design. A retrospective cohort review. Objective. The aim of this study is to investigate whether preoperative malnutrition is an independent risk factor for unplanned 30-day readmission after elective spine surgery. Summary of Background Data. Thirty-day hospital readmission rate is being used as a proxy for quality of care. Accordingly, hospitals and health systems are investing considerable resources into the identification of patients at risk of hospital readmission and designing interventions to reduce the rate of hospital readmissions. Methods. The medical records of 145 patients undergoing elective spine surgery at a major academic medical center were reviewed. Preoperative serum albumin level was assessed on all patients and used to quantify nutritional status. Albumin less than 3.5 g/dL was recognized malnourished. Patient demographics, comorbidities, and postoperative complication rates were collected. The association between preoperative serum albumin level and 30-day readmission rate was assessed via multivariate logistic regression analysis. Results. Baseline characteristics were similar between both groups. Low albumin was found in 28% of patients in this study. Malnourished patients were more likely to experience a postoperative complication and a prolonged duration of hospital stay (3.80 vs. 8.67 days), P = 0.03. Overall, 14.48% of patients were readmitted within 30 days of discharge, with malnourished patients experiencing a three-fold increase in 30-day readmission rates (malnourished: 27.50% vs. nourished: 9.52%, P = 0.02). Binary logistic regression with and without propensity score adjustment for risk factors demonstrated that preoperative malnutrition (low serum albumin level) is an independent predictor of 30-day readmission after elective spine surgery (P = 0.01). Conclusion. Pre-operative malnutrition is an independent risk factor for readmission within 30 days of discharge after elective spine surgery. Laboratory markers of nutrition can identify patients at risk of unplanned hospital readmission. This risk determination identifies a potentially modifiable risk factor for early readmission. Level of Evidence: 3

AB - Study Design. A retrospective cohort review. Objective. The aim of this study is to investigate whether preoperative malnutrition is an independent risk factor for unplanned 30-day readmission after elective spine surgery. Summary of Background Data. Thirty-day hospital readmission rate is being used as a proxy for quality of care. Accordingly, hospitals and health systems are investing considerable resources into the identification of patients at risk of hospital readmission and designing interventions to reduce the rate of hospital readmissions. Methods. The medical records of 145 patients undergoing elective spine surgery at a major academic medical center were reviewed. Preoperative serum albumin level was assessed on all patients and used to quantify nutritional status. Albumin less than 3.5 g/dL was recognized malnourished. Patient demographics, comorbidities, and postoperative complication rates were collected. The association between preoperative serum albumin level and 30-day readmission rate was assessed via multivariate logistic regression analysis. Results. Baseline characteristics were similar between both groups. Low albumin was found in 28% of patients in this study. Malnourished patients were more likely to experience a postoperative complication and a prolonged duration of hospital stay (3.80 vs. 8.67 days), P = 0.03. Overall, 14.48% of patients were readmitted within 30 days of discharge, with malnourished patients experiencing a three-fold increase in 30-day readmission rates (malnourished: 27.50% vs. nourished: 9.52%, P = 0.02). Binary logistic regression with and without propensity score adjustment for risk factors demonstrated that preoperative malnutrition (low serum albumin level) is an independent predictor of 30-day readmission after elective spine surgery (P = 0.01). Conclusion. Pre-operative malnutrition is an independent risk factor for readmission within 30 days of discharge after elective spine surgery. Laboratory markers of nutrition can identify patients at risk of unplanned hospital readmission. This risk determination identifies a potentially modifiable risk factor for early readmission. Level of Evidence: 3

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KW - albumin

KW - hospital readmission

KW - hypoalbuminemia

KW - independent predictor

KW - independent risk factor

KW - malnutrition

KW - preoperative nutritional status

KW - spine

KW - surgery

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