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01-12-2019 | Glioma | Clinical Study

Analysis of intra-operative variables as predictors of 30-day readmission in patients undergoing glioma surgery at a single center

Authors: Iahn Cajigas, Anil K. Mahavadi, Ashish H. Shah, Veronica Borowy, Nathalie Abitbol, Michael E. Ivan, Ricardo J. Komotar, Richard H. Epstein

Published in: Journal of Neuro-Oncology | Issue 3/2019

Abstract

Purpose

Reducing the time from surgery to adjuvant chemoradiation, by decreasing unnecessary readmissions, is paramount for patients undergoing glioma surgery. The effects of intraoperative risk factors on 30-day readmission rates for such patients is currently unclear. We utilized a predictive model-driven approach to assess the impact of intraoperative factors on 30-day readmission rates for the cranial glioma patient.

Methods

Retrospectively, the intraoperative records of 290 patients who underwent glioma surgery at a single institution by a single surgeon were assessed. Data on operative variables including anesthesia specific factors were analyzed via univariate and stepwise regression analysis for impact on 30-day readmission rates. A predictive model was built to assess the capability of these results to predict readmission and validated using leave-one-out cross-validation.

Results

In multivariate analysis, end case hypothermia (OR 0.28, 95% CI [0.09, 0.84]), hypertensive time > 15 min (OR 2.85, 95% CI [1.21, 6.75]), and pre-operative Karnofsky performance status (KPS) (OR 0.63, 95% CI [0.41, 0.98] were identified as being significantly associated with 30-day readmission rates (chi-squared statistic vs. constant model 25.2, p < 0.001). Cross validation of the model resulted in an overall accuracy of 89.7%, a specificity of 99.6%, and area under the receiver operator curve (AUC) of 0.763.

Conclusion

Intraoperative risk factors may help risk-stratify patients with a high degree of accuracy and improve postoperative patient follow-up. Attention should be paid to duration of hypertension and end-case final temperature as these represent potentially modifiable factors that appear to be highly associated with 30-day readmission rates. Prospective validation of our model is needed to assess its potential for implementation as a screening tool to identify patients undergoing glioma surgery who are at a higher risk of post-operative readmission within 30 days

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Title: Analysis of intra-operative variables as predictors of 30-day readmission in patients undergoing glioma surgery at a single center
Authors: Iahn Cajigas
Anil K. Mahavadi
Ashish H. Shah
Veronica Borowy
Nathalie Abitbol
Michael E. Ivan
Ricardo J. Komotar
Richard H. Epstein
Publication date: 01-12-2019
Publisher: Springer US
Keywords: Glioma
Craniotomy
Glioma
Glioma
Published in: Journal of Neuro-Oncology / Issue 3/2019
Print ISSN: 0167-594X
Electronic ISSN: 1573-7373
DOI: https://doi.org/10.1007/s11060-019-03317-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Analysis of intra-operative variables as predictors of 30-day readmission in patients undergoing glioma surgery at a single center

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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