Administrative data sets may overestimate the rate of readmission following spinal surgery

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According to a study published in the Journal of Neurosurgery: Spine, administrative data sets—the current method of calculating readmission rates—may overestimate the rate and cost of readmission following spinal surgery.

Beejal Y Amin, Department of Neurosurgery, University of California, San Francisco, USA, and others reported that readmission (defined as readmission to hospital within 30 days of an index hospitalisation) has been identified as a “key undesirable outcome of patient care” and that reducing the rate of readmissions is seen an important goal for improving patient care. The authors explained that the rate of readmission is often calculated using administrative claims billing data sets and these data can be used to identify potential targets for quality improvement.

However, Amin et al added: “Implementing improvement strategies based on such data assumes accurate identification of complications that are directly attributable to a prior hospital admission. Relying on inaccurate interpretations of administrative data may wrongly attribute reason for readmission or even incorrectly identify complications, which could lead to misguided interventions that are potentially costly and may adversely affect patient outcomes.”

Therefore the aim of their study was to determine if readmission rates calculated from administrative data sets are an accurate reflection of readmission rates at their centre (University of California, San Francisco). Amin et al abstracted data for 5,780 consecutive spinal patients from their centre from an administrative data set to calculate the rate of readmission and compared this rate with the rate from a separate analysis of a manual chart review of each patient.

The authors found that according to the administrative data set, 281 (4.9%) patients were readmitted after an index spinal procedure and the main reasons for readmission were infection, planned surgery, and non-operative management (eg, pain control). However, data from the chart review showed that 69 (25%) of these 281 readmissions should be excluded because they were not true readmissions (ie, not a direct result of the index procedure)—39 were planned readmissions as part of a staged procedure, 14 were surgical cases that were cancelled or rescheduled at index admission due to unpredictable reasons, and 16 were readmissions that were unrelated to spinal surgery. Amin et al commented: “When these 69 cases were excluded, the direct cost of relevant readmissions is actually 29% lower than if the all-cause estimate was used. The cost variance is in excess of US$3 million.”

The authors commented that efforts to reduce these 69 readmissions that were actually “appropriate and unavoidable” would be “unnecessary and potentially use resources that could be directed elsewhere”. They concluded: “Developing more sophisticated algorithms with spine surgeons’ input will increase the reporting accuracy. Surgeons can play a vital role to help improve benchmarking and improve of the value of healthcare provided.”

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