Readmission and reoperation for hydrocephalus: a population-based analysis across the spectrum of age

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  • 1 University of Notre Dame, Notre Dame, Indiana;
  • 2 Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware; and
  • 3 Departments of Neurological Surgery and
  • 4 Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
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OBJECTIVE

Hydrocephalus is a common, chronic illness that generally requires lifelong, longitudinal, neurosurgical care. Except at select research centers, surgical outcomes in the United States have not been well documented. Comparative outcomes across the spectrum of age have not been studied.

METHODS

Data were derived for the year 2015 from the Nationwide Readmissions Database, a product of the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality. In this data set patients are assigned state-specific codes that link repeated discharges through the calendar year. Discharges with diagnostic codes for hydrocephalus were extracted, and for each patient the first discharge defined the index admission. The study event was readmission. Observations were censored at the end of the year. In a similar fashion the first definitive surgical procedure for hydrocephalus was defined as the index operation, and the study event was reoperation for hydrocephalus or complications. Survival without readmission and survival without reoperation were analyzed using life tables and Kaplan-Meier plots.

RESULTS

Readmission rates at 30 days ranged between 15.6% and 16.8% by age group without significant differences. After the index admission the first readmission alone generated estimated hospital charges of $2.25 billion nationwide. Reoperation rates at 30 days were 34.9% for infants, 39.2% for children, 47.4% for adults, and 32.4% for elders. These differences were highly significant. More than 3 times as many index operations were captured for adults and elders as for infants and children. Estimated 1-year reoperation rates were 74.2% for shunt insertion, 63.9% for shunt revision, but only 34.5% for endoscopic third ventriculostomy. Univariate associations with survival without readmission and survival without reoperation are presented.

CONCLUSIONS

In the United States hydrocephalus is predominantly a disease of adults. Surgical outcomes in this population-based study were substantially worse than outcomes reported from research centers. High reoperation rates after CSF shunt surgery accounted for this discrepancy.

ABBREVIATIONS CCS = Clinical Classification Software; CPC = choroid plexus coagulation; ETV = endoscopic third ventriculostomy; NRD = Nationwide Readmissions Database.

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Contributor Notes

Correspondence Joseph Piatt: Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE. jpiatt@nemours.org.

INCLUDE WHEN CITING Published online May 29, 2020; DOI: 10.3171/2020.3.JNS20528.

Disclosures The 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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