Preoperative Emergency Department Visits Predict Potentially Unnecessary Expenditures After Transforaminal Lumbar Interbody Fusion Surgery

Study Design. A national retrospective observational cohort study was conducted using the Merative MarketScan database. Objective. To evaluate whether preoperative ED use was predictive of postoperative readmission, reoperation, and increased overall cost in patients undergoing transforaminal lumbar interbody fusion (TLIF). Summary of Background Data. Emergency department (ED) visits and unplanned readmissions after spine surgery are increasingly financially relevant, as the Centers for Medicare and Medicaid Services levies financial penalties for unplanned 30-day hospital readmission. Methods. The dataset was queried for transforaminal lumbar interbody fusion (TLIF) performed between July 1, 2018 and June 30, 2023. The primary outcome was any postoperative ED visit. Secondary outcomes included 30-day readmissions, 90-day readmissions, major medical complications, any reoperation, and 30-day episode of care costs. Results. A total of 25, 203 patients underwent TLIF during the study period. Multivariate logistic regression demonstrated that at least one preoperative ED visit was predictive for any postoperative ED visit and was also predictive of 30-day complication, 90-day readmission, and 90-day reoperation. A diagnosis of CKD was the strongest predictor for 30-day complication. Multivariate linear regression for total 30-day episode-of-care cost demonstrated that a preoperative ED visit was associated with a 2, 806. 71 increase in total cost. Conclusions. We found that any preoperative ED visit was associated with higher 30-day episode of care costs, increased postoperative ED visits, and higher 90-day readmissions and reoperations following TLIF. Preoperative ED visits may serve as an indicator for unnecessary postoperative 30-day-episode of care utilization. This represents an opportunity for preoperative counseling and intervention to close care gaps and decrease unnecessary healthcare expenditures. Level of Evidence. III