Top

Acta Neurochirurgica

Published in:

Open Access 01-11-2020 | Original Article - Neurosurgery general

Early unplanned readmission of neurosurgical patients after treatment of intracranial lesions: a comparison between surgical and non-surgical intervention group

Authors: Caroline Sander, Henry Oppermann, Ulf Nestler, Katharina Sander, Nikolaus von Dercks, Jürgen Meixensberger

Published in: Acta Neurochirurgica | Issue 11/2020

Abstract

Background

Recent health care policy making has highlighted the necessity for understanding factors that influence readmission. To elucidate the rate, reason, and predictors of readmissions in neurosurgical patients, we analyzed unscheduled readmissions to our neurosurgical department after treatment for cranial or cerebral lesions.

Methods

From 2015 to 2017, all adult patients who had been discharged from our Department of Neurosurgery and were readmitted within 30 days were included into the study cohort. The patients were divided into a surgical and a non-surgical group. The main outcome measure was unplanned inpatient admission within 30 days of discharge.

Results

During the observation period, 183 (7.4%) of 2486 patients had to be readmitted unexpectedly within 30 days after discharge. The main readmission causes were surgical site infection (34.4 %) and seizure (16.4%) in the surgical group, compared to natural progression of the original diagnosis (38.2%) in the non-surgical group. Most important predictors for an unplanned readmission were younger age, presence of malignoma (OR: 2.44), and presence of cardiovascular side diagnoses in the surgical group. In the non-surgical group, predictors were length of stay (OR: 1.07) and the need for intensive care (OR: 5.79).

Conclusions

We demonstrated that reasons for readmission vary between operated and non-operated patients and are preventable in large numbers. In addition, we identified treatment-related partly modifiable factors as predictors of unplanned readmission in the non-surgical group, while unmodifiable patient-related factors predominated in the surgical group. Further patient-related risk adjustment models are needed to establish an individualized preventive strategy in order to reduce unplanned readmissions.

Available only for authorised users

Birkmeyer JD, Dimick JB, Birkmeyer NJO (2004) Measuring the quality of surgical care: structure, process, or outcomes? J Am Coll Surg 198(4):626–632CrossRef

Buchanan CC, Hernandez EA, Anderson JM, Dye JA, Leung M, Buxey F, Bergsneider M, Afsar-Manesh N, Pouratian N, Martin NA (2014) Analysis of 30-day readmissions among neurosurgical patients. Surgical complication avoidance as key to quality improvement. J Neurosurg 121(1):170–175CrossRef

Chern JJ, Bookland M, Tejedor-Sojo J, Riley J, Shoja MM, Tubbs RS, Reisner A (2014) Return to system within 30 days of discharge following pediatric shunt surgery. J Neurosurg Pediatr 13(5):525–531CrossRef

Dasenbrock HH, Yan SC, Chavakula V, Gormley WB, Smith TR, Claus EB, Dunn IF (2017) Unplanned Reoperation after craniotomy for tumor: a national surgical quality improvement program analysis. Neurosurgery 81(5):761–771CrossRef

Dickinson H, Carico C, Nuño M, Mukherjee D, Ortega A, Black KL, Patil CG (2015) Unplanned readmissions and survival following brain tumor surgery. J Neurosurg 122(1):61–68CrossRef

Dignan FL, Potter MN, Ethell ME, Taylor M, Lewis L, Brennan J, McNamara L, Evans SO, Riley U, Davies FE, Dearden CE, Morgan GJ, Shaw BE (2013) High readmission rates are associated with a significant economic burden and poor outcome in patients with grade III/IV acute GvHD. Clin Transpl 27(1):E56–E63CrossRef

Donoho DA, Wen T, Babadjouni RM, Schwartzman W, Buchanan IA, Cen SY, Zada G, Mack WJ, Attenello FJ (2018) Predictors of 30- and 90-day readmission following craniotomy for malignant brain tumors: analysis of nationwide data. J Neuro-Oncol 136(1):87–94CrossRef

Glassman S, Carreon LY, Andersen M, Asher A, Eiskjær S, Gehrchen M, Imagama S, Ishii K, Kaito T, Matsuyama Y, Moridaira H, Mummaneni P, Shaffrey C, Matsumoto M (2017) Predictors of hospital readmission and surgical site infection in the United States, Denmark, and Japan: is risk stratification a universal language? Spine 42(17):1311–1315CrossRef

Kassin MT, Owen RM, Perez SD, Leeds I, Cox JC, Schnier K, Sadiraj V, Sweeney JF (2012) Risk factors for 30-day hospital readmission among general surgery patients. J Am Coll Surg 215(3):322–330CrossRef

10.

Korinek A-M, Golmard J-L, Elcheick A, Bismuth R, van Effenterre R, Coriat P, Puybasset L (2005) Risk factors for neurosurgical site infections after craniotomy: a critical reappraisal of antibiotic prophylaxis on 4,578 patients. Br J Neurosurg 19(2):155–162CrossRef

11.

Lassen B, Helseth E, Rønning P, Scheie D, Johannesen TB, Mæhlen J, Langmoen IA, Meling TR (2011) Surgical mortality at 30 days and complications leading to recraniotomy in 2630 consecutive craniotomies for intracranial tumors. Neurosurgery 68(5):1259–1268 discussion 1268-9CrossRef

12.

Lawson EH, Hall BL, Louie R, Ettner SL, Zingmond DS, Han L, Rapp M, Ko CY (2013) Association between occurrence of a postoperative complication and readmission: implications for quality improvement and cost savings. Ann Surg 258(1):10–18CrossRef

13.

Marcus LP, McCutcheon BA, Noorbakhsh A, Parina RP, Gonda DD, Chen C, Chang DC, Carter BS (2014) Incidence and predictors of 30-day readmission for patients discharged home after craniotomy for malignant supratentorial tumors in California (1995-2010). J Neurosurg 120(5):1201–1211CrossRef

14.

McLaughlin N, Jin P, Martin NA (2015) Assessing early unplanned reoperations in neurosurgery: opportunities for quality improvement. J Neurosurg 123(1):198–205CrossRef

15.

Moghavem N, Morrison D, Ratliff JK, Hernandez-Boussard T (2015) Cranial neurosurgical 30-day readmissions by clinical indication. J Neurosurg 123(1):189–197CrossRef

16.

Morokoff AP, Zauberman J, Black PM (2008) Surgery for convexity meningiomas. Neurosurgery 63(3):427–433 discussion 433-4CrossRef

17.

Nuño M, Ly D, Ortega A, Sarmiento JM, Mukherjee D, Black KL, Patil CG (2014) Does 30-day readmission affect long-term outcome among glioblastoma patients? Neurosurgery 74(2):196–204 discussion 204-5CrossRef

18.

Peeters W, van den Brande R, Polinder S, Brazinova A, Steyerberg EW, Lingsma HF, Maas AIR (2015) Epidemiology of traumatic brain injury in Europe. Acta Neurochir 157(10):1683–1696CrossRef

19.

Schipmann S, Brix T, Varghese J, Warneke N, Schwake M, Brokinkel B, Ewelt C, Dugas M, Stummer W (2019) Adverse events in brain tumor surgery: incidence, type, and impact on current quality metrics. Acta Neurochir 161(2):287–306CrossRef

20.

Schipmann S, Varghese J, Brix T, Schwake M, Keurhorst D, Lohmann S, Suero Molina E, Mauer UM, Dugas M, Warneke N, Stummer W (2019) Establishing risk-adjusted quality indicators in surgery using administrative data-an example from neurosurgery. Acta Neurochir 161(6):1057–1065CrossRef

21.

Senders JT, Muskens IS, Cote DJ, Goldhaber NH, Dawood HY, Gormley WB, Broekman MLD, Smith TR (2018) Thirty-day outcomes after craniotomy for primary malignant brain tumors: a national surgical quality improvement program analysis. Neurosurgery 83(6):1249–1259CrossRef

22.

Shah MN, Stoev IT, Sanford DE, Gao F, Santiago P, Jaques DP, Dacey RG (2013) Are readmission rates on a neurosurgical service indicators of quality of care? J Neurosurg 119(4):1043–1049CrossRef

23.

Schipmann S, Suero Molina E, Windheuser J, Doods J, Schwake M, Wilbers E, Alsofy SZ, Warneke N, Stummer W(2020) The 30-day readmission rate in neurosurgery—a useful indicator for quality assessment? Acta Neurochir (Wien): 1–11

24.

Weeks WB, Lee RE, Wallace AE, West AN, Bagian JP (2009) Do older rural and urban veterans experience different rates of unplanned readmission to VA and non-VA hospitals? J Rural Health 25(1):62–69CrossRef

Title: Early unplanned readmission of neurosurgical patients after treatment of intracranial lesions: a comparison between surgical and non-surgical intervention group
Authors: Caroline Sander
Henry Oppermann
Ulf Nestler
Katharina Sander
Nikolaus von Dercks
Jürgen Meixensberger
Publication date: 01-11-2020
Publisher: Springer Vienna
Published in: Acta Neurochirurgica / Issue 11/2020
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-020-04521-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Early unplanned readmission of neurosurgical patients after treatment of intracranial lesions: a comparison between surgical and non-surgical intervention group

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 11/2020

Tailoring the surgical corridor to the basilar apex in the pretemporal transcavernous approach: morphometric analyses of different neurovascular mobilization maneuvers.

How I do it: endoscopic microvascular decompression for glossopharyngeal neuralgia

Diagnostic reliability of the Berlin classification for complex MCA aneurysms—usability in a series of only giant aneurysms

Surgical management for large vestibular schwannomas: a systematic review, meta-analysis, and consensus statement on behalf of the EANS skull base section

Treatment outcomes of large and giant intracranial aneurysms according to various treatment modalities

The historical evolution of microvascular decompression for trigeminal neuralgia: from Dandy’s discovery to Jannetta’s legacy