Predictors of Hospital Readmission and Surgical Site Infection in the United States, Denmark, and Japan: Is Risk Stratification a Universal Language?
Abstract
<h4>Study design</h4>Retrospective review of three spine surgery databases.<h4>Objectives</h4>The
purpose of the present study is to determine whether predictors of hospital readmission
and surgical site infection (SSI) after lumbar fusion will be the same in United States,
Denmark, and Japan.<h4>Summary of background data</h4>Because clinical decision making
becomes more data driven, risk stratification will be crucial to minimize complications.
Spine surgeons worldwide face this issue, leading to parallel efforts to address risk
stratification. This raises the question as to whether pooled data would be valuable
and whether models generated in one country would be applicable to other populations.<h4>Methods</h4>Predictors
of SSI and 30-day readmission from three prospective databases (National Neurosurgery
Quality and Outcomes Database [N2QOD] N = 2653, DaneSpine N = 1993, Japan Multicenter
Spine Database [JAMSD] N = 3798) were determined and compared to identify common or
divergent predictive risks.<h4>Results</h4>Predictive variables differed in the three
databases, for both readmission and SSI. Factors predictive for hospital readmission
were American Society of Anesthesiologists (ASA) grade in N2QOD (P = 0.013, odds ratio
[OR] 2.08), fusion levels in DaneSpine (P = 0.005, OR 1.67), and sex in JAMSD (P = 0.001,
OR = 2.81). Associated differences in demographics and procedural factors included
mean ASA grade (N2QOD = 2.45, JAMSD = 1.72) and fusion levels (N2QOD = 1.39, DaneSpine = 1.52,
JAMSD = 1.34). For SSI, sex (P = 0.000, OR = 3.30), diabetes (P = 0.000, OR = 2.90),
and length of stay (P = 0.000, OR = 1.02) were predictive in JAMSD. No predictors
were identified in N2QOD or DaneSpine.<h4>Conclusion</h4>Predictors of SSI and hospital
readmission differ in the United States, Denmark, and Japan, suggesting that risk
stratification models may need to be population specific or adjusted. Some differences
in measured parameters exist in the three databases analyzed; however, patient and
procedure selection also appear to differ and may limit the ability to directly pool
data from different regions. Therefore, risk stratification models developed in one
country may not be directly applicable to other countries.<h4>Level of evidence</h4>2.
Type
Journal articleSubject
HumansSurgical Wound Infection
Patient Readmission
Risk Factors
Retrospective Studies
United States
Japan
Denmark
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https://hdl.handle.net/10161/28374Published Version (Please cite this version)
10.1097/brs.0000000000002082Publication Info
Glassman, Steven; Carreon, Leah Y; Andersen, Mikkel; Asher, Anthony; Eiskjær, Soren;
Gehrchen, Martin; ... Matsumoto, Morio (2017). Predictors of Hospital Readmission and Surgical Site Infection in the United States,
Denmark, and Japan: Is Risk Stratification a Universal Language?. Spine, 42(17). pp. 1311-1315. 10.1097/brs.0000000000002082. Retrieved from https://hdl.handle.net/10161/28374.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Christopher Ignatius Shaffrey
Professor of Orthopaedic Surgery
I have more than 25 years of experience treating patients of all ages with spinal
disorders. I have had an interest in the management of spinal disorders since starting
my medical education. I performed residencies in both orthopaedic surgery and neurosurgery
to gain a comprehensive understanding of the entire range of spinal disorders. My
goal has been to find innovative ways to manage the range of spinal conditions, straightforward
to complex. I have a focus on managing patients with complex s

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