Risk factors for 90-day readmission in metastatic spine tumors in South Korea: A nationwide population-based study from 2012 to 2019

doi:10.21203/rs.3.rs-3122934/v1

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Risk factors for 90-day readmission in metastatic spine tumors in South Korea: A nationwide population-based study from 2012 to 2019

https://doi.org/10.21203/rs.3.rs-3122934/v1

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Population-based studies on the cause of readmission within 90 days after surgery or radiotherapy for metastatic spine tumors are scarce. We aimed to investigate the risk factors for readmission within 90 days after initial surgical or radiation treatment for metastatic spine tumors. Patients who were diagnosed with metastatic spine tumors between 2012 and 2019 and who underwent spinal magnetic resonance imaging within 1 year were classified according to treatment (surgical or radiotherapy), and the causes for the 90-day readmission and patient characteristics were compared. Overall, 15,815 patients (surgical group, 13,974 patients; radiotherapy group, 1,841 patients) were evaluated. Radiotherapy was preferred in younger and male patients with high Charlson comorbidity index (CCI). Meanwhile, surgery was mainly performed in patients with lumbar metastasis. Radiotherapy, age 30–69 years, male sex, and CCI > 1 were risk factors for 90-day readmission. The main cause of 90-day readmissions included tumor recurrence, chemotherapy, radiotherapy, and treatment of other organ metastasis with radiotherapy. Patients with lung, breast, liver, and colorectal origin and treated with radiotherapy had a high 90-day readmission rate. Radiotherapy, age 30–69 years, male sex, and CCI > 1 increase the risk for 90-day readmission in patients with metastatic spine tumors.

Population aging has resulted in an increased number of oncology patients, and accordingly, the number of patients with metastatic spine tumors has also increased. Spinal metastasis occurs in approximately 5–10% of patients with primary cancer^1,2 such as prostate, breast, lung, liver, kidney, and thyroid cancers. The incidence and survival rates of metastatic spine tumors are increasing with the improvement in diagnostic modalities and treatment outcomes, but the incidence of primary cancers is also increasing. Currently, treatments for patients with these metastatic spine tumors range from minimally invasive procedures such as chemotherapy, radiotherapy, and vertebroplasty to extensive surgical treatment. The treatment method for patients with metastatic spine tumors is determined according to patient status, location and extent of metastasis, neurologic status, and spinal stability.^3,4 Surgical treatment is performed to improve quality of life by prolonging overall survival, improving gait, and maintaining bowel and bladder function through nerve decompression and spinal stabilization.⁵ In addition, radiotherapy is also performed in many patients. However, the majority of patients with metastatic spine tumors are readmitted and provided additional treatments.

Population-based research facilitates both the formulation of care plans by physicians and the identification of strategies to efficiently allocate health care resources by health care providers. However, population-based studies of readmission within 90 days of patients with metastatic spine tumors have been conducted in a few studies but are limited despite the growing interest in this topic. In particular, there are few Class I studies on the causes of readmission within 90 days by treatment modality for patients with metastatic spinal tumors. Thus, the aim of this study was to investigate the risk factors for readmission within 90 days after initial surgical or radiation treatment for metastatic spine tumors, using the Korean Review and Assessment Service data.

Ethics statement

This study was approved by the Institutional Review Board of Ajou University Medical Center (Number: AJIRB-MED-EXP-21-276) and adhered to the tenets of the Declaration of Helsinki. All methods were performed in accordance with the relevant guidelines and regulations. All participants agreed to fill out an informed consent form.

Data Source and Collection

Health Insurance Review and Assessment Service (HIRA) data (National Health Insurance Service-2018-2-142) of 79,732 patients with metastatic spine tumors collected by the National Health Insurance Service between 2012 and 2019 were analyzed. Briefly, the HIRA data are coded based on the International Classification of Diseases (ICD, 10th revision) system. Data of all patients aged ≥ 0 year are included. To verify the identity of the study cohort, only patients with codes C795, M8449, M8448, M485, and M4851–9 and who underwent spinal MRI within 1 year after diagnosis were included (Fig. 1). In addition, based on the ICD-10 code, the patients were classified into two groups according to whether they received surgery (N0284-6, N2461-3, N2464-6, N0466, N1466, N2467-9, N0468, N0469, N0472-5, N1791, N1767, N2497, N1492, N1498, N2498, N1493, N1499, and N04715) or radiotherapy (HD05, HD06, HD07, HD08, HD09, HD111, HD112, and Z510). Patients who underwent other treatments, such as chemotherapy without surgery or radiotherapy, were excluded. Patient age was classified into < 30, 30–49, 50–69, and ≥ 70 years. Readmission rate within 90 days and the duration of hospitalization during readmission were confirmed. The primary tumor site was determined according to the tumor code identified 5 years preoperatively and 1 year postoperatively. The location of the lesion was classified as cervical, thoracic, and lumbar. Surgery was classified into tumor resection, instrumentation, decompression, and cementation. Radiotherapy was classified into teletherapy, 3D conformal therapy, and others.

Cause of readmission within 90 days

The causes for readmission within 90 days were divided into surgical and non-surgical and compared between the two groups. The causes were confirmed according to the ICD-10 code at the time of admission. Surgical causes were categorized into tumor recurrence (ICD-10 codes HD05–12, Z510, U99), wound infection (ICD-10 codes T79, T81, M46.3, and M86.9), postoperative hematoma (ICD-10 codes S24.1 and S34.1), neurogenic bladder (ICD-10 codes G83.4 and N31.9), and neurological complications (ICD-10 codes K59.2, G80, G82). Non-surgical causes were categorized into chemotherapy (ICD-10 codes Z08.2, Z09.2, Z29.2, Z51.1, Z54.2, and Z92.6), radiotherapy (ICD-10 codes HD05–12 and Z510), gastrointestinal diseases (ICD-10 codes K29, K59, K21, and R11), cardiovascular diseases (ICD-10 codes B37.6, I20–25, I27, and I43), pulmonary diseases (ICD-10 codes J06, J11, J12–18, J22, J69, J84, J85, and I26), urological diseases (ICD-10 code N31), renal failure (ICD-10 codes C79, N00.8, N17, N18, and N19), dermatological diseases (ICD-10 codes L08.8 and L08.9), skeletal diseases (ICD-10 codes M48, M81, S22, and S32), other organ metastasis (ICD-10 code C79). For example, readmission for chemotherapy was considered as hospitalization for chemotherapy if there was a chemotherapy code or if there was a history of prescription of chemotherapy drugs without any other special ICD-10 code after readmission within 90 days.

Statistical analysis

Baseline characteristics were evaluated using descriptive analysis. Categorical variables are presented as frequencies and percentages (%), while continuous variables are presented as the mean (standard deviation) or median (interquartile range). Patient characteristics were compared between the groups using the χ2 test, t-test, and Wilcoxon’s rank-sum test. Univariable and multivariable logistic regression analyses were performed to assess the risk factors of readmission within 90 days after initial treatment. The causes of readmissions were compared between the two groups using the χ2 test or Fisher’s exact test. The primary sites of cancer and readmission rates for each primary site were also compared between the two groups using the χ2 test. All statistical analyses were performed using SAS version 9.4 (SAS Institute, Cary, NC, USA). All tests were two-sided, and P values < 0.05 indicated statistical significance.

Among the 79,732 patients who were diagnosed with metastatic spine tumors, 32,362 patients underwent spinal magnetic resonance imaging (MRI) within 1 year. Of them, 15,815 patients who underwent surgical treatment or radiotherapy within 1 year after diagnosis of metastatic spine tumors were evaluated. In total, 13,974 and 1,841 patients underwent surgical treatment and radiotherapy, respectively. The surgical group was older than the radiotherapy group (73.96 ± 10.54 years vs 63.19 ± 11.83 years). Particularly, surgical treatment was performed more frequently than radiation treatment in patients aged ≥ 70 years (P < 0.0001). Radiotherapy was performed more frequently in men rather than women (57.90%, P < 0.0001). There was no difference in the type of insurance among the patients. A high Charlson comorbidity index (CCI) and residence in the city were associated with a higher probability of radiotherapy (P < 0.0001). The 3-year survival rate was higher with surgical treatment than with radiotherapy (72.69% vs 17.21%, P < 0.0001). The 90-day readmission rate was significantly higher in the radiotherapy group than in the surgical group (64.64% vs 40.02%, P < 0.0001). Further, the duration of readmission was slightly longer in the surgery group than in the radiation therapy group (13 days vs 9 days, P < 0.0001) (Table 1).

Table 1

Baseline patient characteristics (n = 15,815)
Characteristics	Surgery N = 13,974	Radiotherapy N = 1,841	P value
Age at the initial treatment, mean (SD)	73.96 (10.54)	63.19 (11.83)	< .0001
Age group (years), n (%)			< .0001
≤ 29	81 (0.58)	13 (0.71)
30–49	307 (2.20)	214 (11.62)
50–69	3,221 (23.05)	995 (54.05)
≥ 70	10,365 (74.17)	619 (33.62)
Sex, n (%)			< .0001
Male	4,043 (28.93)	1,066 (57.90)
Female	9,931 (71.07)	775 (42.10)
Insurance type, n (%)			0.0501
Health insurance	13,852 (99.13)	1,833 (99.57)
Medical aid and others	122 (0.87)	8 (0.43)
Charlson Comorbidity Index, n (%)			< .0001
0	1,611 (11.53)	41 (2.23)
1	2,118 (15.16)	41 (2.23)
2	2,394 (17.13)	113 (6.14)
≥ 3	7,851 (56.18)	1,646 (89.41)
Hospital region, n (%)			< .0001
Seoul	4,025 (28.80)	783 (42.53)
Neighboring city¹⁾	6,851 (49.03)	786 (42.69)
Another city	3,098 (22.17)	272 (14.77)
3-year survival rate²⁾, n (%)	6,038 (72.69)	191 (17.21)	< .0001
Readmission within 90 days, n (%)	5,592 (40.02)	1,190 (64.64)	< .0001
Length of hospital stay at readmission (days)³⁾, median [IQR]	13 [5,36]	9 [3, 23]	< .0001
Characteristics of treatment
Surgery type, n (%)
Tumor resection	923 (5.11)	-
Anterior instrumentation	451 (2.50)	-
Posterior instrumentation	5,921 (32.80)	-
Decompression	1,918 (10.62)	-
Cementation	8,841 (48.97)	-
Lesion location, n (%)
Cervical	473 (2.62)	-
Thoracic	1,981 (10.97)	-
Lumbar	6,716 (37.20)	-
Unknown	8884 (49.21)
Radiotherapy type, n (%)
Teletherapy, rotational irradiation	-	650 (29.82)
3D conformal therapy, unsealed source	-	1,362 (62.48)
Others	-	168 (7.70)
Total*	18,054 (100.00)	2,180 (100.00)
1) Neighboring cities include Busan, Daegu, Incheon, Gwangju, Daejeon, Ulsan, and Gyung-gi.
2) Patients who did not have enough follow up days were excluded (n = 6,353 in 2017–2019)
3) Only for patients who were readmitted within 90 days after initial treatment (n = 6,782)
* Total includes count duplicates

Among the types of surgery, cementation was the most common (8,841 cases [48.97%]), followed by posterior instrumentation (5,921 cases [32.80%]). Meanwhile, among the types of radiotherapy, 3D conformal therapy and an unsealed source were the most commonly used (1,362 cases [62.48%]). The location of the lesion was not accurately identified in most cases, but in cases where the location of the lesion was confirmed, the most common was the lumbar area (6,716 cases [37.20%]) (Table 1).

The readmission rate after 90 days was 40.02% (n = 5,592) in the surgical group and 64.64% (n = 1,190) in the radiotherapy group. The rehospitalization rate was significantly higher in the radiotherapy group than in the surgical group (P < 0.0001). Univariate logistic regression analysis showed that initial treatment with radiotherapy, old age, and a high CCI, and male sex were associated with 90-day readmission. The multivariate analysis showed that initial treatment with radiotherapy, old age, male sex, and high CCI were independent factors of 90-day readmission (Table 2).

Table 2

Univariate and multivariate logistic regression analyses of the influencing factors of readmission within 90 days after initial treatment
Variables	Unadjusted odds ratio (95% CI)	P value	Adjusted odds ratio (95% CI)	P value
Starting treatment
Surgery	Ref.		Ref.
Radiotherapy	2.74 (2.48, 3.03)	< .0001	1.92 (1.72, 2.14)	< .0001
Age group (years)
≤ 29	0.97 (0.64, 1.47)	0.8965	1.11 (0.72, 1.71)	0.6338
30–49	1.96 (1.64, 2.34)	< .0001	1.47 (1.22, 1.77)	< .0001
50–69	1.42 (1.33, 1.53)	< .0001	1.17 (1.08, 1.26)	< .0001
≥ 70	Ref.		Ref.
Sex
Male	1.63 (1.52,1.74)	< .0001	1.33 (1.24,1.43)	< .0001
Female	Ref.		Ref.
Charlson Comorbidity Index
0	Ref.		Ref.
1	1.18 (1.02,1.35)	0.0233	1.24 (1.08, 1.43)	0.0027
2	1.55 (1.35, 1.77)	< .0001	1.60 (1.40, 1.84)	< .0001
≥ 3	2.47 (2.20, 2.77)	< .0001	2.24 (2.00, 2.52)	< .0001
Hospital region
Seoul	1.06 (0.97, 1.15)	0.2322	0.90 (0.82, 0.99)	0.0274
Neighboring city*	0.99 (0.91, 1.07)	0.7446	0.93 (0.85, 1.01)	0.0731
Another city	Ref.		Ref.
* Neighboring cities include Busan, Daegu, Incheon, Gwangju, Daejeon, Ulsan, and Gyung-gi.

Regarding the causes for readmission, both groups were more likely to be re-hospitalized for non-surgical causes (78.8% vs 57.6%), and the radiotherapy group was relatively more hospitalized for surgical causes than the surgical group (42.4% vs 21.2%) (Fig. 2). Tumor recurrence was the most common surgical cause in both groups, and the rate was significantly higher in the radiotherapy group than in the surgery group (41.66% vs 19.22%, P < 0.0001). For non-surgical causes, skeletal diseases are the most common in the surgical group (27.08%), followed by gastrointestinal diseases (22.32%), cardiovascular diseases (12.01%), and urological disease (2.74%) (P < 0.0001). Meanwhile, chemotherapy (18.49%), gastrointestinal diseases (14.88%), and radiotherapy (7.46%) were the more common causes in the radiotherapy group (P < 0.0001). Hospitalization due to metastases in other organs was also significantly more frequent in the radiotherapy group (P < 0.0001) (Table 3).

Table 3

Cause of readmission within 90 days after initial treatment (n = 6,782)
Cause of readmission	Overall n = 6,782	Surgery n = 5,592	Radiotherapy n = 1,190	P value
Patients with specified causes, n (%)	6,515 (96.06)	5,331 (95.33)	1,184 (99.50)
Surgical causes
1- Tumor recurrence	2,555 (25.38)	1,404 (19.22)	1,151 (41.66)	< .0001
2- Wound infection	36 (0.36)	29 (0.40)	7 (0.25)	0.2810
3- Postop hematoma	8 (0.08)	7 (0.10)	1 (0.04)	0.4594
4- Neurogenic bladder	9 (0.09)	9 (0.12)	-	0.1261
5- Neurological complication	101 (1.00)	89 (1.22)	12 (0.43)	0.0004
Non-surgical causes
6- Chemotherapy	1,202 (11.94)	697 (9.46)	511 (18.49)	< .0001
7- Radiotherapy	314 (3.12)	108 (1.48)	206 (7.46)	< .0001
8- Gastrointestinal diseases	2,041 (20.28)	1,630 (22.32)	411 (14.88)	< .0001
9- Cardiovascular diseases	1,042 (10.35)	877 (12.01)	165 (5.97)	< .0001
10- Pulmonary diseases	253 (2.51)	184 (2.52)	69 (2.50)	0.9493
11- Urological diseases	239 (2.37)	200 (2.74)	39 (1.41)	< .0001
12- Renal failure	70 (0.70)	54 (0.74)	16 (0.58)	0.3877
13- Dermatological diseases	7 (0.07)	6 (0.08)	1 (0.04)	0.6818
14- Skeletal diseases	2,084 (20.70)	1,978 (27.08)	106 (3.84)	< .0001
15- Other organ metastasis	105 (1.04)	37 (0.51)	68 (2.46)	< .0001
Total*	10,066 (100.00)	7,303 (100.00)	2,763 (100.00)
* Total includes count duplicates

The most common primary tumor site was the lung, followed by the colorectal region in the surgical group and the liver in the radiotherapy group. Both primary sites were favorable for radiotherapy, and radiotherapy was performed significantly more frequently for cancers in these sites (P < 0.0001). Meanwhile, surgery was performed significantly more frequently for colorectal cancer, possibly owing to its moderate resistance to radiotherapy (P < 0.0001)⁶ (Table 4). When analyzed according to the primary cancer site, the 90-day readmission rate in the radiotherapy group was higher in patients with primary lung, breast, liver, and colorectal tumors. In the surgery group, the 90-day readmission rate for all primary cancer sites was reported to be lower than that of the radiation treatment group, and there was no statistical difference in prostate and musculoskeletal patients compared to the radiation therapy group. (Table 5).

Table 4

Primary tumor site by treatment type
Primary site		Surgery n = 13,974	Radiotherapy n = 1,841	P value
Patients with known primary cancer, n (%)		4,399 (31.78)	1,839 (98.34)	-
	Lung (C34)	733 (15.02)	491 (26.16)	< .0001
	Breast (C50)	169 (3.46)	148 (7.88)	< .0001
	Prostate (C61)	401 (8.22)	113 (6.02)	0.0023
	Liver (C22)	504 (10.33)	171 (9.11)	0.1349
	Musculoskeletal (C40, C41)	98 (2.01)	72 (3.84)	< .0001
	Colorectal (C18–C20)	514 (10.53)	126 (6.71)	< .0001
	Not specified above	2,461 (50.43)	756 (40.28)
Total*		4,880 (100.00)	1,877 (100.00)	-
* Total includes count duplicates

Table 5

Comparison of readmission rate by treatment modality for each primary site
Primary site	Surgery n (%)	Radiotherapy n (%)	P value
Lung (C34)	421 (57.44)	327 (66.60)	0.0013
Breast (C50)	76 (44.97)	87 (58.78)	0.0141
Prostate (C61)	197 (49.13)	66 (58.41)	0.0813
Liver (C22)	279 (55.36)	115 (67.25)	0.0064
Musculoskeletal (C40, C41)	43 (43.88)	39 (54.17)	0.1846
Colorectal (C18–C20)	262 (50.97)	89 (70.63)	< .0001

This study used data of patients registered in the HIRA. In Korea, all clinic and hospital charges for diagnosis and treatment and other medical costs of both inpatients and outpatients are reimbursed according to the national health policy. It is mandatory to report information for effective data collection, and thus, the HIRA database is suitable for big data research. In addition, HIRA data can be used in epidemiological studies.

Patients treated for metastatic spine tumors are often readmitted within 90 days of discharge, but data on the cause of the hospitalization are lacking. Most studies reported were retrospective research,^7,8 and data on the cause of readmission within 90 days according to the treatment method for metastatic spine tumors are rare. Readmissions provide an important parameter into understanding postoperative morbidity among patients with metastatic spine tumors.⁹ If the cause for readmission within 90 days can be identified and reduced, it will provide a good resource for lowering morbidity and medical costs. To our best knowledge, this study is the first to evaluate the risk factors for readmission within 90 days after treatment for metastatic spine tumors using nationwide population data.

Recent advances in cancer treatment such as molecular targeted drugs for lung and renal cancers and hormonal therapy for breast and prostate cancers have increased the survival rates. However, the proportion of patients with metastatic spine tumors have also increased.^10–12,13 Various scoring systems for metastatic spine tumors such as the Tokuhashi, Tomita, Baur, Linden, Rades, and Katagiri scores have been proposed to evaluate survival using prognostic factors to establish treatment plans.¹⁴ Meanwhile, the Spinal Neoplastic Instability Score is used in tumors related to mechanical instability to decide the appropriateness of surgical intervention. In general, surgery is performed for patients with a high life expectancy of more than 6 months.¹⁵ In the current study, among the 15,815 patients with metastatic spine tumors, 13,974 patients received surgical treatment, and only 1,841 patients received radiotherapy, confirming the preference for surgical treatment. In addition, the 3-year survival rate was higher in the surgical group (72.69%) than in the radiotherapy group (17.21%), and this can be because surgical intervention is mainly performed for patients who are expected to have a good prognosis and higher life expectancy. Further, radiotherapy was performed significantly more frequently in metastatic spine tumors with lung and breast origins (P < 0.0001). Meanwhile, surgery was performed significantly more frequently in metastatic spine tumors with colorectal primary cancer, which is radiation-resistant (P < 0.0001). The current findings confirm that radiosensitivity of the primary tumor was a major factor in deciding treatment for metastatic spine tumors.

This study found that radiotherapy was the primary factor contributing to readmission within 90 days, along with male sex and age 30–69 years. Additionally, a high CCI increased the risk of readmission within 90 days. Patients with a poor prognosis or short life expectancy are often primarily treated with radiotherapy, and patients who receive radiotherapy are more likely to have recurring tumors, requiring additional hospitalization for non-surgical causes such as chemotherapy or radiotherapy. Several studies have shown a high readmission rate in patients who have already received radiotherapy.^16–18 Our study also found that males had a higher rate of readmission, likely owing to receiving radiotherapy more frequently based on the demographics of the study. Other studies have reported higher readmission rates with a high CCI or excessive polypharmacy.¹⁹ Similarly, our study found that a high CCI (> 1) was associated with higher readmission rates.

The readmission rate was significantly higher in the radiotherapy group than in the surgical group (P < 0.0001). In the radiotherapy group, the most common surgical cause for readmission was tumor recurrence, while the most common non-surgical causes were chemotherapy and gastrointestinal diseases. This shows that gastrointestinal diseases are a major cause of readmission within 90 days in both surgery and radiotherapy treatment for metastatic spine tumors. Among patients who undergo surgery, gastrointestinal complications may occur owing to decreased motility from narcotic analgesics used after surgery or from limitations in ambulation caused by postoperative pain.^20,21 Meanwhile, among patients who undergo radiotherapy, gastrointestinal complications occur owing to radiation-related damage to healthy cells, which leads to intestinal inflammation or irritation. This in turn results in radiation enteritis and other events such as diarrhea, nausea, vomiting, stomach cramp, and small bowel obstruction.^22,23

This study has some limitations. First, similarly to other studies using population-based data, the results may be underestimated. Given that there is no specific ICD-10 code for “metastatic spine tumor,” we identified patients to have metastatic spine tumors when spine MRI was performed within 1 year, after searching for the “secondary neoplasm of bone” code. Additionally, a multidisciplinary panel of spinal surgeons, epidemiologists, and radiation oncologists identified the primary and metastatic spine tumors. Additional measures are necessary to define metastatic spine tumors. Second, the causes for readmission may be more than suggested in this study, and the decision to readmit a patient for treatment-related complications was at the discretion of individual physicians. Studies including population-based data use the ICD-10 code, and thus, diseases with no ICD-10 code may have been excluded in the search. However, we checked the causes of readmission suggested by other studies in advance and conducted the study by including as many representative codes as possible. Third, recent treatment strategies for metastatic spine tumors involve not only one modality but a combination of surgery, radiation, and chemotherapy. In this study, both radiotherapy and surgical therapy were performed in some patients. The treatment methods may be unclear because treatment can be performed simultaneously during one hospital stay. To overcome this limitation, only the first treatment method registered was included in the analysis, with a focus on when the code was registered in the database, and the order of classification of treatment methods was determined.

In patients with metastatic spine tumors, radiotherapy, age 30–69 years, male sex, and CCI > 1 are associated with a higher rate of readmission within 90 days after initial treatment. Patients who receive radiotherapy first are more commonly readmitted owing to tumor recurrence and also require additional chemotherapy or radiotherapy. Meanwhile, patients who receive surgical therapy first are commonly readmitted for non-surgical causes of gastrointestinal diseases, skeletal diseases, and cardiovascular diseases. This study offers a better understanding for the causes of readmission among patients with metastatic spine tumors, and the findings can be helpful in reducing postoperative morbidity and medical costs among these patients.

Acknowledgements

It is a pleasure to convey my gratitude to the people who contributed in different ways to the research. Foremost, I thank all the participants of this research for their effort and time to help with this research.

Author contributions

Sung Hyun Noh and Hyung Cheol Kim wrote the main manuscript text.

Sang Hyun Kim were in charge of statistical analysis and preparing figure.

Pyung Goo Cho contributed to study design, acquisition of data, analysis of data, and interpretation of results.

All authors reviewed the manuscript.

Data availability statement

The datasets used or analyzed during the current study are available from the corresponding author on reasonable request.

Conflict of Interest and Source of Funding

This work was supported and funded by the Ajou University Medical Center from Republic of Korea under Grant [number M-2021-C0460-00057]. The all authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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No competing interests reported.

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Risk factors for 90-day readmission in metastatic spine tumors in South Korea: A nationwide population-based study from 2012 to 2019

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Introduction

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Data Source and Collection

Cause of readmission within 90 days

Statistical analysis

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