1. Jimmy Nguyen and Paul Arnold, M.D.
Factors Influencing 30-day Readmission Following Traumatic Spinal Cord Injury
Jimmy Nguyen and Paul Arnold, M.D.

2. Disclosures: click to add text

3. Traumatic Spinal Cord Injury (TSCI)
● Distortion of the spinal cord
● Fracture of one or more of the bony elements
●Dislocation at one or more joints
●Tearing of ligament(s)
●Disruption and/or herniation of the intervertebral disc
●12,400 annually
 In the United States, the incidence of TSCI in 2010 was about 40 per million persons per year, or about 12,400 annually [3], with approximately 250,000 living survivors of TSCI in the United States in July 2005.
Source:

4. TSCI Surgery
Goals: Reduction of dislocation and decompression of spine
Evidence: Low
Indications: Dependent on surgeon’s personal experience
Goals for surgical intervention in TSCI include stabilization of the spine, as well as reduction of dislocations and decompression of neural elements. There are no evidence-based guidelines regarding the indications for or timing of surgery in TSCI [98]. In general, the specific management of cervical, thoracic, and lumbar spine and spinal cord injuries depends to a large extent on a surgeon's personal experience and practice norms in his or her center.
The decision to treat with surgery depends on each surgeon’s personal experience and local practice norms. There are proposed grading scales for decision making, however they have not been prospectively studied or adopted by practicing surgeons.
Source:

5. Research Question
What are the risk factors involved in the readmission of TSCI patients within 30-days after surgery?

6. Defining TSCI Traumatic Spinal Cord injury:
ICD 10: S14.1, S24.1, S34.1
ICD 9: 806, 952
Number of Patients: 2225
Hagen 2009: These ICD 10 code have 0.83 sensitivity and 0.97 specificity.
Previously used by: Cooper 2015, Gabbe 2016, Chen 2011

7. Defining TSCI Surgery Neurosurgery
Procedures on Spine (ICD9, ICD10, CPT)
Number of Patients: 158 (UHC)

8. Readmission Risk Factors
Moghavem 2015
Readmission for trauma indicated cranial neurosurgery
Yarbrough 2016
Readmission after spinal cord injury (excluding surgery)
Hammond 2016
Readmission after traumatic brain injury
​Sherrod 2016
Readmission after pediatric neurosurgery

9. Readmission Risk Factors
Pre-existing Factors
Age, Sex, Race
Heart Failure HT
Paralysis
Chronic Pulmonary Disease
Coagulopathy
Obesity
Alcohol Abuse
Depression
Diabetes
Payer Status
Post-operative Factors:
Pulmonary Complications: pneumonia, pneumothorax, pleural effusion, atelectasis
DVT
Wound complications: wound infection (icd ), disruption of wound
UTI
Length of stay

10. Outcomes
Re-admitted < 30days in the UHC
Number of Patients: 60

11. Results Readmitted Not Readmitted Black Race Patients 10 7
Non-Black Race Patients 50 91
Readmitted
Not Readmitted
Medicaid Payer 17 13
Non-Medicaid 43 85
Relative Risk :1.66
95% Confidence interval:
Relative Risk :1.69
95% Confidence interval:

12. Conclusion
Most importantly, medical comorbidities failed to significantly increase risks for readmission.
Higher risks of 30-day readmission were found in patients with Black race and Medicaid payer status.
In the pursuit of improving care and reducing readmissions, these results inform how socioeconomic factors impact recovery from TSCI.

13. Citations
[1] Hagen Diagnostic coding accuracy for traumatic spinal cord injuries.
[2] Cooper Mortality and Readmissions After Cervical Fractures From Falls In Older Adults: A Comparison To Hip Fractures Using National Medicare Data.
[3] Gabbe Profile and costs of secondary conditions resulting in emergency department presentations and readmission to hospital following traumatic spinal cord injury.
[4] Chen Defining neurotrauma in administrative data using the International Classification of Diseases Tenth Revision. online.biomedcentral.com/articles/ /
[5] Moghavem Cranial neurosurgical 30-day readmissions by clinical indication.
[6] Hammond Readmission to Acute Care Hospital during Inpatient Rehabilitation for Traumatic Brain Injury.
[7] Sherrod Risk factors for unplanned readmission within 30 days after pediatric neurosurgery: a nationwide analysis of 9799 procedures from the American College of Surgeons National Surgical Quality Improvement Program.