BACKGROUND: Hospital readmission is a key surgical quality metric associated with financial penalties and greater healthcare costs. We examined the clinical risk factors and postoperative complications associated with 30-day unplanned hospital readmissions after cranial neurosurgery. METHODS: We queried the American College of Surgeons National Surgical Quality Improvement Program database from 2011 to 2016 for adult patients who had undergone a cranial neurosurgical procedure. Multivariable logistic regression with backward model selection was used to determine the predictors associated with 30-day unplanned hospital readmission. RESULTS: Of 40,802 cranial neurosurgical cases, 4147 (10.2%) required an unplanned readmission. Postoperative complications were greater in the readmission cohort (18.5% vs. 9.9%; P < 0.001). On adjusted analysis, the clinical factors predictive of unplanned readmission included hypertension, chronic obstructive pulmonary disease, diabetes, coagulopathy, chronic steroid use, and preoperative anemia, hyponatremia, and hypoalbuminemia (P ≤ 0.01 for all). Higher American Society of Anesthesiology class (III to V), operative time >216 minutes, and unplanned reoperation were also associated with an increased likelihood of readmission (P ≤ 0.001 for all). The postoperative complications predictive of unplanned readmissions were wound infection (odds ratio [OR], 4.90; P < 0.001), pulmonary embolus (OR, 3.94; P < 0.001), myocardial infarction or cardiac arrest (OR, 2.37; P < 0.001), sepsis (OR, 1.73; P < 0.001), deep venous thrombosis (OR, 1.50; P = 0.002), and urinary tract infection (OR, 1.45; P = 0.002). Female sex, transfer status, and postoperative pulmonary complications were protective of readmission (P < 0.05 for all). CONCLUSIONS: Unplanned hospital readmission after cranial neurosurgery is a common event. The identification of high-risk patients who undergo cranial procedures might allow hospitals to reduce unplanned readmissions and their associated healthcare costs.
BACKGROUND: Hospital readmission is a key surgical quality metric associated with financial penalties and greater healthcare costs. We examined the clinical risk factors and postoperative complications associated with 30-day unplanned hospital readmissions after cranial neurosurgery. METHODS: We queried the American College of Surgeons National Surgical Quality Improvement Program database from 2011 to 2016 for adult patients who had undergone a cranial neurosurgical procedure. Multivariable logistic regression with backward model selection was used to determine the predictors associated with 30-day unplanned hospital readmission. RESULTS: Of 40,802 cranial neurosurgical cases, 4147 (10.2%) required an unplanned readmission. Postoperative complications were greater in the readmission cohort (18.5% vs. 9.9%; P < 0.001). On adjusted analysis, the clinical factors predictive of unplanned readmission included hypertension, chronic obstructive pulmonary disease, diabetes, coagulopathy, chronic steroid use, and preoperative anemia, hyponatremia, and hypoalbuminemia (P ≤ 0.01 for all). Higher American Society of Anesthesiology class (III to V), operative time >216 minutes, and unplanned reoperation were also associated with an increased likelihood of readmission (P ≤ 0.001 for all). The postoperative complications predictive of unplanned readmissions were wound infection (odds ratio [OR], 4.90; P < 0.001), pulmonary embolus (OR, 3.94; P < 0.001), myocardial infarction or cardiac arrest (OR, 2.37; P < 0.001), sepsis (OR, 1.73; P < 0.001), deep venous thrombosis (OR, 1.50; P = 0.002), and urinary tract infection (OR, 1.45; P = 0.002). Female sex, transfer status, and postoperative pulmonary complications were protective of readmission (P < 0.05 for all). CONCLUSIONS: Unplanned hospital readmission after cranial neurosurgery is a common event. The identification of high-risk patients who undergo cranial procedures might allow hospitals to reduce unplanned readmissions and their associated healthcare costs.
Authors: Iahn Cajigas; Anil K Mahavadi; Ashish H Shah; Veronica Borowy; Nathalie Abitbol; Michael E Ivan; Ricardo J Komotar; Richard H Epstein Journal: J Neurooncol Date: 2019-10-22 Impact factor: 4.130
Authors: Ryan Lee; Danny Lee; Ishwarya S Mamidi; William V Probasco; Jessica H Heyer; Rajeev Pandarinath Journal: Clin Orthop Relat Res Date: 2019-02 Impact factor: 4.176
Authors: Carlos J Cobeñas; Laura L Lombardi; Priscila Pereyra; Emanuel De Rose; María José Gogorza; Ana Paula Spizzirri; Javier D Ruscasso; Soledad Luján Ferradas; Ángela Del Carmen Suárez; Oscar R Amoreo; Javier H Zalba; Paula Risso Journal: Pediatr Nephrol Date: 2021-03-13 Impact factor: 3.714