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Preoperative ASA grade predicts odds of 90-day readmission and outcomes at 24 months following anterior or posterior CSM surgery: A report from the Quality Outcomes Database

Friday, May 3, 2024

    Presenting Author(s)

  • Mohamed Macki, MD, MPH

    Neurosurgeon
    Cleveland Clinic
    San Francisco, California, United States

    • Co-Author(s)

  • VA

    Vardhaan S. Ambati, MS

    Medical Student
    University of California San Francisco
    San Jose, California, United States

  • Anthony L. Asher, MD

    President AANS, Clinical Professor
    Neuroscience Institute, Carolina Neurosurgery & Spine Associates
    Charlotte, North Carolina, United States

  • Erica F. Bisson, MD, MPH

    Professor
    University of Utah
    Salt Lake City, UT, US

  • Mohamad Bydon, MD

    Professor of Neurosurgery
    Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55902, USA
    Rochester, Minnesota, United States

  • Andrew K. Chan, MD

    Assistant Professor of Neurological Surgery
    Columbia University Irving Medical Center
    New York, NY, US

  • Dean Chou, MD

    Chief of the Spine Division, Professor, and Vice Chair of Neurosurgery
    Columbia University
    New York, New York, United States

  • Domagoj Coric, MD

    Neurosurgeon
    Carolina Neurosurgery & Spine Associates
    Charlotte, NC, US

  • Anthony M. DiGiorgio, DO, MHA

    Assistant Professor
    Department of Neurological Surgery, University of California, San Francisco
    San Francisco, California, United States

  • Kevin T. Foley, MD

    Professor
    Semmes-Murphey Neurologic and Spine Institute, University of Tennessee
    Memphis, TN, US

  • KF

    Kai-Ming Fu, MD, PhD

    Associate Professor
    Weill Cornell Medical Center
    New York, NY, US

  • OG

    Oren N. Gottfried, MD

    Professor of Neurosurgery
    Duke University
    Durham, North Carolina, United States

  • RH

    Regis Haid, MD

    Neurosurgeon
    Atlanta Brain and Spine Care, United States

  • John Knightly, MD

    Director of Neurosurgery
    Atlantic Neurosurgical Specialists
    Morristown, New Jersey, United States

  • SM

    Scott Meyer, MD

    Neurosurgery
    Altair Health
    Minneapolis, Minnesota, United States

  • Praveen V. Mummaneni, MD, MBA

    Joan O'Reilly Endowed Professor and Vice Chair of Neurosurgery
    Department of Neurological Surgery, University of California, San Francisco
    San Francisco, CA, US

  • Paul Park, MD

    Neurosurgeon
    Semmes Murphey Clinic
    MEMPHIS, Tennessee, United States

  • Eric Potts, MD

    Neurosurgeon
    Goodman Campbell Brain and Spine
    Carmel, IN, US

  • Christopher I. Shaffrey, MD

    Professor of Spine Surgery
    Duke University Medical Center
    Durham, NC, US

  • MS

    Mark E. Shaffrey, MD

    Professor
    University of Virginia
    Charlottesville, Virginia, United States

  • Luis M. Tumialán, MD

    Professor of Neurosurgery
    Barrow Brain and Spine
    Paradise Valley, Arizona, United States

  • Cheerag Upadhyaya, MD, MBA (he/him/his)

    Vice Chair of Outpatient Operations, Chief of Business Development and Strategy, Associate Professor of Neurosurgery
    University of North Carolina
    Chapel Hill, North Carolina, United States

  • Juan S. Uribe, MD

    Neurosurgeon
    Barrow Neurological Insitute
    Phoenix, Arizona, United States

  • MV

    Michael S. Virk, MD, PhD

    Assistant Professor
    Weill Cornell Medical Center
    New York, New York, United States

  • Michael Y. Wang, MD

    Professor
    University of Miami
    Miami, FL, US

Introduction: Despite the prevalence of cervical spinal myelopathy (CSM), the clinical risk factors for readmission and poor outcomes are not well defined. We aim to identify if American Society of Anesthesiologists (ASA) grade associates with readmission and poor outcomes following CSM surgery.

Methods: Prospectively-collected data from the Quality Outcomes Database registry CSM cohort were used. The primary outcome measures were 90-day readmission rates and 24-month patient reported outcomes. Statistically significant variables in univariate analysis were included in multivariate logistic regression.

Results: Overall, 1,141 CSM patients were enrolled with 1128 reaching 24-month follow-up (median cohort ASA grade:3). Of these, 62 (5.5%) were readmitted within 90 days. Readmission indications (not mutually exclusive) included 6 (0.53%) hematomas, 6 (0.53%) wound dehiscences, 6 (0.53%) new spinal cord deficits, 5 (0.44%) surgical site infections, 2 (0.18%) new nerve root injuries/deficits, 2 (0.18%) pain admissions, 1 (0.09%) hardware revision, and 1 (0.09%) dysphagia case; the remaining were medical complications. Univariate analysis found increased age (OR per 1-year increase: 1.03, p=0.005), coronary artery disease (CAD) (OR:2.5,p=0.007), and increased ASA grade (OR per 1-point increase:2.9, p< 0.001) to be significantly associated with increased 90-day readmissions. Multivariate logistic regression controlling for age, BMI, ambulation status, CAD, and baseline mJOA and NDI scores found increased ASA grade (aOR per 1-point increase:2.5, adjusted-p:0.002) to be the only studied variable significantly associated with increased 90-day readmission rates. Further, increased ASA grade was an independent predictor of reduced quality-adjusted life year (QALY) (Lin. Reg. Coeff=-0.04, adjusted-p=0.007), and increased NDI (Lin. Reg. Coeff:3.5, adjusted-p:0.005) scores at 24 months.

Conclusion : Patients undergoing anterior or posterior CSM surgery have relatively low (5.5%) 90-day readmission rates. Higher ASA grade independently predicts 90-day readmissions and inferior 24-month outcomes, including quality of life and neck-pain-related disability. Careful discharge planning/thorough patient education for patients with higher ASA grade may be indicated to reduce this risk.