Clinical studyHospital-acquired conditions occur more frequently in elective spine surgery than for other common elective surgical procedures
Introduction
Within the last decade there has been a paradigm shift within the healthcare system with increasing emphasis on value based care. This holds true for patients undergoing spine surgery in an effort to optimize quality and safety. Despite advances in perioperative management and surgical technique, patients undergoing spine surgery remain at risk for complication with varying rates in the literature [1], [2], [3]. A subset of these complications are viewed as preventable conditions and have been classified as hospital-acquired conditions (HACs), or the so called “never events”. HACs encompass a broad group of comorbidities and complications with select International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes including surgical site infection (SSI), venous thromboembolism (VTE), and urinary tract infections (UTI).
In 2008, the Centers for Medicare and Medicaid Services formulated an initiative focusing on HACs and how these adverse events are managed within the healthcare system. As part of the initiative, HACs and their associated treatment are no longer reimbursed in the inpatient setting [4]. As such, in addition to having a detrimental effect on patient care, HACs have a significant financial impact on providers, hospital institutions, and patients [5], [6], [7]. Limiting these complications is therefore important to improve both the quality of patient care and to optimize resource allocation.
The objective of this study was to assess the national prevalence of HACs in patients undergoing spine surgery. We focused on the three most common HACs in this patient population: surgical site infection, venous thromboembolism, and urinary tract infections [8], [9]. These rates were then compared to those for other common surgical procedures with the goal of defining baseline data for outcome improvement and to aid in the development of prevention strategies.
Section snippets
Data sources
The American College of Surgeons’ National Surgical Quality Improvement Program (ACS-NSQIP) database was utilized for this study. ACS-NSQIP was developed by the Department of Veterans Affairs in order to track surgical interventions across US hospitals. NSQIP tracks 135 clinical metrics, including pre-operative risk factors and demographics, intra-operative variables, and 30-day post-operative outcomes using Current Procedural Terminology (CPT) and International Classification of Disease 9th
Study sample – Spine surgery patients
90,551 elective spine surgery patients were identified in the NSQIP database, of which 3021 (3.3%) developed at least one HAC (Table 2). SSI was the most common HAC (1.4%), followed by UTI (1.3%) and VTE (0.8%). Stratified by surgery type, fusion procedures were associated with higher rates of overall HACs compared to decompression-only procedures (3.8% vs 2.7%, p < 0.001) as well as higher rates of each individual HAC (SSI: 1.5% vs 1.3%, UTI: 1.5% vs 0.9%, and VTE: 1.0% vs 0.5%, all p < 0.05).
HACs compared between spine surgery and bariatric surgery
Discussion
With growing focus on value-based care in the current healthcare system, greater emphasis has been placed on improving system efficiency: reducing readmissions, complications, and errors. [12] As such, one solution has been to limit, as much as possible, certain defined preventable hospital-acquired complications (HACs) known as “never events” – meaning they should never occur given that the standard of care is upheld. [10] The Centers for Medicare and Medicaid Services formulated a plan in
Conclusion
HACs developed with greater frequency in elective spine surgery patients than in other common elective procedures including bariatric surgery and THA (3.4% vs 2.8%, p < 0.001); with SSI, being the most common HAC in spine surgery at 1.4%. Additionally, within elective spine surgery, fusion procedures were associated with higher rates of overall HACs compared to decompression-only procedures (3.8% vs 2.7%, p < 0.001). HACs occurred more frequently in cardiothoracic surgery, colectomy, and
Disclosure of funding related to current work
Peter G Passias MD – Reports personal consulting fees for Spinewave, Zimmer Biomet, DePuy Synthes, and Medicrea outside the submitted work.
Ethical review committee statement
Not applicable given that it is de-identified nationally-available data.
CRediT authorship contribution statement
Samantha R. Horn: Formal analysis, Investigation, Methodology, Writing - original draft. Frank A. Segreto: Resources, Software. Haddy Alas: Writing - original draft. Cole Bortz: Visualization, Software. Brendan Jackson-Fowl: Project administration, Validation. Avery E. Brown: Supervision, Writing - review & editing. Katherine E. Pierce: Visualization, Investigation. Dennis Vasquez-Montes: Data curation, Formal analysis. Max I. Egers: Writing - review & editing. Breton G. Line: Resources,
Declaration of Competing Interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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