90-Day Emergency Department Utilization and Readmission Rate After Full-Endoscopic Spine Surgery: A Multicenter, Retrospective Analysis of 821 Patients

Jannik Leyendecker; Tobias Prasse; Christine Park; Malin Köster; Lena Rumswinkel; Tara Shenker; Eliana Bieler; Peer Eysel; Jan Bredow; Mark M Zaki; Varun Kathawate; Edward Harake Jr; Rushikesh S Joshi; Sanjay Konakondla; Osama N Kashlan; Peter Derman; Albert Telfeian; Christoph P Hofstetter; Endoscopic Spine Research Group (ESRG)

doi:10.1227/neu.0000000000003095

90-Day Emergency Department Utilization and Readmission Rate After Full-Endoscopic Spine Surgery: A Multicenter, Retrospective Analysis of 821 Patients

Neurosurgery. 2024 Jul 18. doi: 10.1227/neu.0000000000003095. Online ahead of print.

Authors

Jannik Leyendecker^{1

2}, Tobias Prasse², Christine Park¹, Malin Köster², Lena Rumswinkel², Tara Shenker³, Eliana Bieler¹, Peer Eysel², Jan Bredow^{2

4}, Mark M Zaki⁵, Varun Kathawate⁵, Edward Harake Jr⁵, Rushikesh S Joshi⁵, Sanjay Konakondla⁶, Osama N Kashlan⁵, Peter Derman⁷, Albert Telfeian⁸, Christoph P Hofstetter¹; Endoscopic Spine Research Group (ESRG)

Affiliations

¹ Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.
² Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
³ College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale-Davie, Florida, USA.
⁴ Department of Orthopedics and Trauma Surgery, Krankenhaus Porz am Rhein, University of Cologne, Cologne, Germany.
⁵ Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
⁶ Department of Neurosurgery, Geisinger Neuroscience Institute, Danville, Pennsylvania, USA.
⁷ Texas Back Institute, Plano, Texas, USA.
⁸ Department of Neurosurgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.

PMID: 39023273
DOI: 10.1227/neu.0000000000003095

Abstract

Background and objectives: Emergency department (ED) utilization and readmission rates after spine surgery are common quality of care measures. Limited data exist on the evaluation of quality indicators after full-endoscopic spine surgery (FESS). The objective of this study was to detect rates, causes, and risk factors for unplanned postoperative clinic utilization after FESS.

Methods: This retrospective multicenter analysis assessed ED utilization and clinic readmission rates after FESS performed between 01/2014 and 04/2023 for degenerative spinal pathologies. Outcome measures were ED utilizations, hospital readmissions, and revision surgeries within 90 days postsurgery.

Results: Our cohort includes 821 patients averaging 59 years of age, who underwent FESS. Most procedures targeted the lumbar or sacral spine (85.75%) while a small fraction involved the cervical spine (10.11%). The most common procedures were lumbar unilateral laminotomies for bilateral decompression (40.56%) and lumbar transforaminal discectomies (25.58%). Within 90 days postsurgery, 8.0% of patients revisited the ED for surgical complications. A total of 2.2% of patients were readmitted to a hospital of which 1.9% required revision surgery. Primary reasons for ED visits and clinic readmissions were postoperative pain exacerbation, transient neurogenic bladder dysfunction, and recurrent disk herniations. Our multivariate regression analysis revealed that female patients had a significantly higher likelihood of using the ED (P = .046; odds ratio: 1.77, 95% CI 1.01-3.1 5.69% vs 10.33%). Factors such as age, American Society of Anesthesiologists class, body mass index, comorbidities, and spanned spinal levels did not significantly predict postoperative ED utilization.

Conclusion: This analysis demonstrates the safety of FESS, as evidenced by acceptable rates of ED utilization, clinic readmission, and revision surgery. Future studies are needed to further elucidate the safety profile of FESS in comparison with traditional spinal procedures.