Alterations in 90-day morbidity, mortality, and readmission rates following spine surgery in Medicare Accountable Care Organizations (2009-2014)

The Spine Journal : Official Journal of the North American Spine Society
Andrew J SchoenfeldJames D Kang

Abstract

The impact of Accountable Care Organizations (ACOs) on healthcare quality and outcomes, including morbidity, mortality, and readmissions, has not been substantially investigated, especially following spine surgery. To evaluate the impact of ACO formation on postoperative outcomes in the 90-day period following spine surgery. Retrospective review of national Medicare claims data (2009-2014). Patients who underwent one of four lumbar spine surgical procedures in an ACO or non-ACO. The development of in-hospital mortality, complications or hospital readmission within 90 days of the surgical procedure. The primary outcome measures included postsurgical complications and readmissions at 90 days following surgery. In-hospital mortality and 30-day outcomes were considered secondarily. The primary predictor variable consisted of ACO enrollment designation. Multivariable logistic regression analysis was utilized to adjust for confounders and determine the independent effect of ACO enrollment on postsurgical outcomes. The multivariable model included a propensity score adjustment that accounted for factors associated with the preferential enrollment of patients in ACOs, namely, sociodemographic characteristics, medical co-morbidities, ho...Continue Reading

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