Causes and Timing of Unplanned Early Readmission After Neurosurgery. Issue 3 (September 2016)

• Record Type: Journal Article
• Authors: Taylor, Blake E. S.; Youngerman, Brett E.; Goldstein, Hannah; Kabat, Daniel H.; Appelboom, Geoffrey; Gold, William E.; Connolly, Edward Sander
• Is Part Of: Neurosurgery. Volume 79:Issue 3(2016)
• Publication Date: 2016-09
• Subjects: Neuroepidemiology -- Neurosurgery -- Quality improvement -- Readmission; Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1227/NEU.0000000000001110
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract : BACKGROUND: Reducing the rate of 30-day hospital readmission has become a priority in healthcare quality improvement policy, with a focus on better characterizing the reasons for unplanned readmission. In neurosurgery, however, peer-reviewed analyses describing the patterns of readmission have been limited in their number and generalizability. OBJECTIVE: To determine the incidence, timing, and causes of 30-day readmission after neurosurgical procedures. METHODS: We conducted a retrospective longitudinal study from 2009 to 2012 using the Statewide Planning And Research Cooperative System, which collects patient-level details for all admissions and discharges within New York. We identified patients readmitted within 30 days of initial discharge. The rate of, reasons for, and time to readmission were determined overall and within 4 subgroups: craniotomies, cranial surgery without craniotomy, spine, and neuroendovascular procedures. RESULTS: There were 163 743 index admissions, of whom 14 791 (9.03%) were readmitted. The most common reasons for unplanned readmission were infection (29.52%) and medical complications (19.22%). Median time to readmission was 11 days, with hemorrhagic strokes and seizures occurring earlier, and medical complications and infections occurring later. Readmission rates were highest among patients undergoing cerebrospinal fluid shunt revision and malignant tumor resection (15.57%-22.60%). Spinal decompressions, however, accounted for the largest volume of readmissions (33.13%). CONCLUSION: Many readmissions may be preventable and occur at predictable time intervals. The causes and timing of readmission vary significantly across neurosurgical subgroups. Future studies should focus on detecting specific complications in select cohorts at predefined time points, which may allow for interventions to lower costs and reduce patient morbidity. ABBREVIATIONS: CSF, cerebrospinal fluid IQR, interquartile range SPARCS, Statewide Planning And Research Cooperative System Abstract : Supplemental Digital Content is Available in the Text.