DOS 2019

DOS Kongressen 2019 · 185 Readmission following complex spine surgery in a prospective cohort of 679 patients – 2-years follow up using the Spine AdVerse Event Severity (SAVES) system Tanvir Johanning Bari, Sven Karstensen, Mathias Dahl Sørensen, Martin Gehrchen, John Street, Benny Dahl Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital; Combined Neurosurgical and Orthopedic Spine Program, Vancouver General Hospital, University of British Columbia, Canada; Department of Orthopedics and Scoliosis Surgery, Texas Children’s Hospital & Baylor College of Medicine, TX, USA Background: Adverse events (AEs) in spine surgery are attracting attention. Recent studies suggest that prospective registration more accurately reflects the true incidence. To our knowledge, no previous study has investigated prospectively registered AEs´ in- fluence on hospital readmission following spine surgery. Purpose / Aim of Study: To determine the frequency of unplanned readmissions after complex spine surgery, and to investigate if prospectively registered AEs can predict readmissions. Materials and Methods: All patients undergoing surgery, at our tertiary referral center, were consecutively and prospectively included in 2013. Demographics and periopera- tive AEs were registered using the Spine AdVerse Events Severity system. Patients were followed for a minimum of 2 years. A competing risk survival model was used to estimate rates of readmissions with death as a competing risk. Multivariate logistic regression analysis and proportional odds survival models were used to assess predictors of i) 30- day readmission to any department and ii) readmission to a spine center at any time point. Results were reported as odds ratios (OR) with 95% confidence intervals (95%CI). Findings / Results: We included 679 patients undergoing surgery for various spine pathologies (deformity, degenerative, tumor, trauma and infection). Within 2 years of index discharge, 443 (65%) were readmitted. Only 20% of readmissions were to a spine center. Cumulative incidence (95%CI) of readmission was estimated to 13% (10-16%) at 30 days, 26% (23-30%) at 90 days, 50% (46- 54%) at 1 year, and 59% (55-63%) at 2 years following discharge. Increased odds of 30-day readmission were correlated to intraoperative hypotension (P=0.02) and major intraoperative blood loss (P<0.01). Readmission to a spine center at any time point was associated to number of instru- mented vertebra (P=0.047), major intraoperative AE (P=0.01) and intraoperative hy- potension (P<0.01). Conclusions: Readmission following complex spine surgery was more frequent than previously reported. Factors related to major intraoperative blood loss were associated to increased odds of readmission. This should be considered during planning of postop- erative observation and care. 141.