Significance of Hospital Size in Outcomes of Single-Level, Elective Anterior Cervical Discectomy and Fusion: A Nationwide Readmissions Database Analysis.

Abstract

OBJECTIVE\nTo elucidate risk factors for 90-day readmission in ACDF for small, medium, and large hospitals respectively. To assess differences in length of stay, charges, and complication rates across hospitals of different size.\n\n\nMETHODS\nThis was a retrospective analysis utilizing elective, single-level ACDF data from 2016-2018 in the HCUP Nationwide Readmissions Database (NRD). Elective single-level ACDF cases were stratified into three groups by hospital bed size (small, medium, and large). All-cause complication rates, mean charges, length of stay, and 90-day readmission rates were compared across hospital size. Frequencies of specific comorbidities were compared between readmitted and non-readmitted patients for each hospital size. Comorbidities significant on univariate analysis were evaluated as independent risk factors for 90-day readmission for each hospital size using multivariate regression.\n\n\nRESULTS\nThe overall 90-day readmission rate was 6.43% in 36,794 total patients, and the rates for small, medium, and large hospitals were 6.25%, 6.28%, and 6.56% respectively (p=0.537). Length of stay increased significantly with hospital size (p<0.001), and small hospitals had the lowest charges (p<0.001). While different independent predictors of 90-day readmission were identified for each hospital size, Cardiac Arrhythmia, Chronic Pulmonary Disease, Neurological Disorders, and Rheumatic Disease were identified as risk factors for hospitals of all sizes.\n\n\nCONCLUSIONS\nHospital size is a determining factor for charges and length of stay associated with elective single-level ACDF. Variation in risk factors for readmission exist across hospital size in context of similar 90-day readmission rates.