Tool helps surgeons preoperatively determine readmission after spine fusion
LOS ANGELES — Results of a preoperative score — the readmission after posterior spine fusion or RAPSF score — can help predict which patients are likely to require readmission after elective one- and two-level posterior lumbar fusion. Furthermore, it may help during joint decision-making to assess whether a patient is indicated for surgery or requires presurgical optimization, a presenter said.
The validated score gives more points, which indicate a greater likelihood of a 30-day readmission, to a patient for older age and hemiplegia or paraplegia, for example, Deeptee Jain, MD, of University of California, San Francisco, said at the North American Spine Society Annual Meeting. A patient older than 90 years receives 8 points on the RAPSF score vs. 6 points for age between 70 and 79 years and 4 points for age between 60 and 69 years, according to the abstract.
Jain said she and her colleagues decided to study readmissions as an indicator of spine surgery quality because “readmissions have become an important component of quality of care.”
Researchers used inpatient databases from five states to identify patients for the case-control study that involved developing the score and validating it using 92,262 patients in a derivation cohort and 90,257 patients in a validation cohort who had 30-day readmission rates, respectively, of 10.9% and 11.1%.
“What we demonstrated in the study is that we created and validated a useful tool – the return after posterior spine fusion – to accurately predict the 30-day readmission in patients undergoing one- to two-level elective posterior lumbar spine fusion. [A] one-point increase on this score is associated with an increase of 1.1% in risk of 30-day readmission,” Jain said.
Weaknesses of the study were its use of an administrative database and coding errors that possibly impacted some demographic variables, she said.
“We excluded patients with high RAPSF scores, greater than 41 in this case,” according to Jain. She said it might be difficult to arrive at accurate readmission rates for these patients because so few of them had such high RAPSF scores. In addition, patients with the highest RAPSF scores already had 100% readmission rates, Jain noted.
“Predictive modeling can be used to risk-stratify patients to guide informed decision-making when undergoing surgery and, additionally, it can also be used to influence value-based payment models, such as the bundled payment care initiative, which is increasingly coming to our field,” she said. – by Susan M. Rapp
Jain D, et al. Paper 12. Presented at: North American Spine Society Annual Meeting; Sept. 26-29, 2018; Los Angeles.
Disclosure: Jain reports no relevant financial disclosures.