Thoracolumbar Burst Fractures: Risk Factors Associated with 90-Day Readmissions- A Nationwide Readmissions Database Study

Introduction: Thoracolumbar (TL) burst fractures occur at the TL junction and may adversely affect neurologic integrity. Complex patient comorbidities may significantly increase utilization of hospital resources including hospital readmissions. The study objective is to investigate readmissions with associated comorbid risks factors and payer status within 90-days after sustaining a TL burst fracture. Finally, we will calculate the total hospital cost for readmission within 90-days after a TL burst fracture.

Methods: We performed a retrospective cohort study of all adult patients (> 18 years) in the 2018 United States National Readmissions Database (NRD) and using ICD-10 coding system identified patients with a new single level TL burst fracture between January and September 2018. Demographics were collected and analyzed for patient, comorbidities, hospital characteristics, readmission, length of stay, hospital cost, and payer status. Statistical analyses were performed, p< .05 was considered statistically significant.

Results: A total of 4,395 patients sustained TL burst fractures as identified by the 2018 NRD; 90-day readmission rate was 7.0% (307/4,395). Of the readmitted patients 69/307 (22%) were surgical patients; 60% of readmitted patients were females (p =.005). Mean age of patients who were readmitted (65.5, SD 17.6) was significantly higher, p<.001. Among the readmitted patients, Medicare recipients represented the most common payer status (11%). Total hospital costs were significantly greater for those who were readmitted ($224,445, SD $184,681).

Conclusion : The 90-day unplanned readmission rate following thoracolumbar burst fracture was 7.0%, with a majority of these having been treated conservatively. Readmitted patients were older in age (> 65 years old) with multiple medical comorbidities/risks factors and supported by Medicare. Overall, there was a substantial increase in hospital costs for readmitted patients. The identified risk factors and treatment groups of patients who sustain thoracolumbar burst fractures are potential areas to focus in order to reduce readmissions and improve outcomes.