JAAOS - 2026-09-15 - Journal Article
Factors Associated With Readmission to the Hospital Within 90-Days Following Elective Lumbar Fusion Surgery.
Lu S, Vander Voort W, Saade A, Shahzad H, Zhao A, Javidan Y, Klineberg E, Khan S, Le H
Topics
Key Takeaway
Discharge to SNF/IRF after elective lumbar fusion independently predicts 2.24 times higher odds of 90-day readmission compared to home discharge, even after multivariate adjustment.
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Summary
This study examined whether discharge disposition independently predicts 90-day ED visits and readmission in 495 patients undergoing elective lumbar fusion at a single academic center from 2018–2022. On multivariate analysis, SNF/IRF discharge carried 2.24 times higher odds of readmission (P=0.012) versus home discharge, but the association with ED visits was nonsignificant (OR 1.03, P=0.927). The unadjusted readmission odds ratio of 3.81 attenuated substantially after controlling for patient and surgical confounders, suggesting discharge disposition is a marker of patient complexity rather than a sole driver.
Key Limitation
Readmissions to outside hospitals were not captured, likely underestimating the true 90-day readmission rate and potentially biasing the SNF/IRF group—who may seek care at multiple facilities—more than the home discharge group.
Original Abstract
STUDY DESIGN
A retrospective cohort study.
OBJECTIVE
To evaluate the impact of discharge disposition on the rates of return to the emergency department (ED) and readmission following elective lumbar fusion surgery (ELFS).
METHODS
This study retrospectively reviewed patients aged ≥18 years old who underwent ELFS for degenerative pathology at a single academic institution between 2018 and 2022. A review of medical records was conducted to collect data on patient and surgical characteristics. Patients were categorized into two groups: Home Health and Skilled Nursing Facility (SNF) and Inpatient Rehabilitation Facility (IRF). ED visits and readmissions within 3 months postoperatively were recorded. Univariate and multivariate regression models were used to identify independent factors associated with ED presentation or readmission.
RESULTS
A total of 495 patients were included. Of the patients, 414 were discharged home, and 81 were discharged to a SNF/IRF. In the univariate analysis, discharge to a SNF or IRF was associated with 3.81 times higher odds of readmission ( P < 0.01) and 1.51 times higher odds of ED visits ( P = 0.15) compared with discharge to home. After adjusting for confounders in the multivariate analysis, the odds ratios for readmission and ED visits were 2.24 ( P = 0.012) and 1.03 ( P = 0.927), respectively.
CONCLUSION
Patients discharged to a SNF or IRF after ELFS had markedly higher odds of readmission within 3 months postoperatively, even after adjusting for patient and surgical factors. However, this association was not observed for ED visits. These findings underscore the need for careful consideration of discharge planning to optimize postoperative outcomes and reduce healthcare utilization following ELFS.