WCRI: WC Patients with Back Surgeries Have Higher Readmission, Reoperation Rates

Nancy Grover

Cambridge, MA (WorkersCompensation.com) – About 1 in 10 Injured workers who undergo lumbar spine surgeries in North Carolina or Minnesota are likely to be readmitted to a hospital and/or have a reoperation. In California, the odds jump to 1 in 5 injured workers, according to a new study.

“What are the factors underlying these interstate variations? That’s a topic for future research,” said Rebecca Yang, senior Public Policy analyst for the Workers Compensation Research Institute. During a recent webinar Yang outlined the findings of the study highlighting readmission and reoperation rates among injured workers and how they compare with those of non-workers’ compensation patients.

The Research

Readmission refers to an unplanned hospitalization after a patient has been discharged, while reoperation is any surgical procedure that must be repeated or performed because the initial procedure was inadequate. They are the two main markers of quality of care used by non-workers’ compensation payors. Understanding these rates and how they compare can help inform stakeholders as well as patients considering lumbar surgery.

For the study, the researchers looked at discectomy/decompression, and fusion surgeries among injured workers with 2016 injuries at 24 months maturity in 18 states. Those included had low back pain as the primary condition. Approximately 3,000 cases, or about 1 in 10 people with low back pain are likely to have surgery, according to the study.

WC vs. Non-WC Patients

Injured workers have higher readmission or reoperation rates than those not in the workers’ compensation system, the study indicated. Where 7 percent of workers’ compensation patients had reoperation or readmission within 30 days of the initial surgery, the percentage among non-workers’ compensation patients was between 4.4 percent and 6.4 percent, according to other studies.

To better understand why, the researchers looked at the readmission/reoperation rates for those with discectomy/decompression surgeries and those who had undergone fusions. “We found 17.1 percent of workers’ compensation patients were readmitted within 30 days of a fusion. That is two-to-seven times higher than the rate of non-workers’ compensation patients. It was the primary driver of all cost admission rates among workers’ compensation patients. “

For those patients who had undergone discectomy/decompression surgeries, the rate for readmission rate within 30 days was 3.2 percent. “Comparable or lower than the rates for non-workers’ compensation patients,” Yang said.

Patients requiring an additional surgery typically underwent the same type of operation as the initial lumber surgery, especially among those who underwent fusion surgery. “That may suggest a mechanical failure or implant failure at the fusion site of the initial procedure,” Yang said. “It may indicate the persistence of pain post-surgery that led to the identification of the pain generator that is different [from that] during the initial procedure. Those are possible reasons underlying the [need for] repeating fusions.”

Why Readmissions

“Most non-operative readmissions were multifactual,” Yang said, “demographic, provider-related, procedure-related, related to inadequate health system processes, or variations in the care delivery, for example, the length of stay or social factors.”

Injured workers who were readmitted to a hospital and did not need another operation generally fell into at least one of four major categories:

  1. Medical conditions ongoing or new but were worsened after surgery, such as high blood pressure, neurological issues, urologic medication side effects, or blood loss.
  2. Functional limitations, where activities of daily living became unmanageable.
  3. Wound complications or infections.
  4. Pain could not be controlled post discharge.

The “single most common reason was medical complications,” Yang said. “The east common one was pain related.

Among fusion patients the second most common reason for readmission was limitations in functional activities. Those who underwent discectomy/decompression surgeries were likely to have wound complications or infections.

Costs

Total medical payments per claim for discectomy/decompression surgeries average $34,282, while costs for initial fusion surgeries run about $91,859. But the cost percentage increases substantially more for readmissions of discectomy/decompression patients than those with fusions — up to $55,298, or 61 percent higher among discectomy/decompression patients, while the $104,242 average cost for readmission of fusion patients is just 13 percent higher.

The researchers determined the costs of the discectomy/decompression vs. fusions, along with the readmission, reoperation, and both readmission/reoperation rates:

Discectomy/decompressioFusion

Initial Procedure: $34,282 $91,859

Readmission: $55,562 $130,265

Reoperation: $55,562 $130,265

Both: $123,452 $164,489

The information from the study can be used to help stakeholders and regulators, for example, to benchmark results against other states. It can also be used for patient engagement.

“Everybody talks about patient satisfaction … everybody has a tool. But patient engagement is a different thing; how to get them to participate in their own care,” said Randall D. Lea, MD, senior Research fellow for WCRI. “A lot of conversations have started to come up around shared decision-making. If you’re having a talk with a patient about lumbar fusion, if you say ‘there’s a 17 percent chance you’ll be readmitted within 90 days, especially if you have comorbidities,’ it gives patients an opportunity to at least be more information about what they are up against.”

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