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Nitin Mukerji, Alistair Jenkins, Claire Nicholson and Patrick Mitchell

to improve the quality of services provided. 1 , 3 , 5 , 13 , 15 No such data exist for pediatric neurosurgery, however. 2 , 9 Thus, we attempted to use our hospital data to determine whether unplanned reoperation rates could be used as a quality indicator. 9 Methods This study was conducted in a tertiary neurosurgical center in North East England with a catchment population of approximately 3 million. At the time of the study, there were 3 designated pediatric neurosurgical consultants (in a team of 11 attending neurosurgeons) and 10 registrars (residents

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Sebastian Lohmann, Tobias Brix, Julian Varghese, Nils Warneke, Michael Schwake, Eric Suero Molina, Markus Holling, Walter Stummer and Stephanie Schipmann

M easuring the quality of delivered care has gained increasing attention in all medical fields over the past decade. Healthcare administrators have begun to consider quality aspects for remuneration purposes, an aspect that has also been implemented in the field of neurosurgery. 1 For this purpose, various performance and quality indicators are under current investigation, aiming at measuring the quality of care. Among them are the 30-day reoperation rate, the 30-day readmission rate, and nosocomial infection and mortality rates. 2–7 Not only should quality

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Jacob K. Greenberg, Chad W. Washington, Ridhima Guniganti, Ralph G. Dacey Jr., Colin P. Derdeyn and Gregory J. Zipfel

OBJECT

Hospital readmission is a common but controversial quality measure increasingly used to influence hospital compensation in the US. The objective of this study was to evaluate the causes for 30-day hospital readmission following aneurysmal subarachnoid hemorrhage (SAH) to determine the appropriateness of this performance metric and to identify potential avenues for improved patient care.

METHODS

The authors retrospectively reviewed the medical records of all patients who received surgical orendovas-cular treatment for aneurysmal SAH at Barnes-Jewish Hospital between 2003 and 2013. Two senior faculty identified by consensus the primary medical/surgical diagnosis associated with readmission as well as the underlying causes of rehospitalization.

RESULTS

Among 778 patients treated for aneurysmal SAH, 89 experienced a total of 97 readmission events, yielding a readmission rate of 11.4%. The median time from discharge to readmission was 9 days (interquartile range 3–17.5 days). Actual hydrocephalus or potential concern for hydrocephalus (e.g., headache) was the most frequent diagnosis (26/97, 26.8%), followed by infections (e.g., wound infection [5/97, 5.2%], urinary tract infection [3/97, 3.1%], and pneumonia [3/97, 3.1%]) and thromboembolic events (8/97, 8.2%). In most cases (75/97, 77.3%), we did not identify any treatment lapses contributing to readmission. The most common underlying causes for readmission were unavoidable development of SAH-related pathology (e.g., hydrocephalus; 36/97, 37.1%) and complications related to neurological impairment and immobility (e.g., thromboembolic event despite high-dose chemoprophylaxis; 21/97, 21.6%). The authors determined that 22/97 (22.7%) of the readmissions were likely preventable with alternative management. In these cases, insufficient outpatient medical care (for example, for hyponatremia; 16/97, 16.5%) was the most common shortcoming.

CONCLUSIONS

Most readmissions after aneurysmal SAH relate to late consequences of hemorrhage, such as hydrocephalus, or medical complications secondary to severe neurological injury. Although a minority of readmissions may potentially be avoided with closer medical follow-up in the transitional care environment, readmission after SAH is an insensitive and likely inappropriate hospital performance metric.

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Christopher J. Coroneos, Sophocles H. Voineskos, Marie K. Coroneos, Noor Alolabi, Serge R. Goekjian, Lauren I. Willoughby, Forough Farrokhyar, Achilleas Thoma, James R. Bain and Melissa C. Brouwers

multidisciplinary centers. Timing was assessed relative to quality indicators established by experts in the guideline group. The secondary objective was to determine the incidence and risk factors for OBPI in Canada. This study will help guide formation of a clinical practice guideline by addressing limitations in the literature, generating and measuring quality indicators for care processes, providing a robust analysis of the incidence trend, and expressing risk factors with strength of association. Methods Personnel The Canadian OBPI Working Group was established to

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Nancy McLaughlin, Peng Jin and Neil A. Martin

entities and procedures. 25 Importantly, neurosurgery has relatively high morbidity and mortality rates in comparison with other surgical specialties. 15 Review of morbidities and mortality has been the primary method of assessing surgical quality used by physicians, hospitals, and oversight agencies. 10 , 17 , 20 In recent years, the reoperation rate, defined as the percentage of patients undergoing a new operation, has been proposed as a quality indicator, a surrogate for surgical adverse events. 4 , 13 , 19 , 24 General surgery has been at the fore-front of

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Ole Solheim, Asgeir Store Jakola, Sasha Gulati and Tom Børge Johannesen

known if an inferior perioperative mortality rate at a single center also reflects actual quality of care or longer term treatment results. Nevertheless, surgical mortality has been endorsed as an Inpatient Quality Indicator by the US Agency for Healthcare Research and Quality in 8 surgical procedures for adults, including craniotomies. Surgical mortality rates are also increasingly publicly reported as an indicator of hospital quality (for example, http://health.usnews.com/best-hospitals/rankings ), despite often considerable limitations in data concerning

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Seokchun Lim, Andrew T. Parsa, Bobby D. Kim, Joshua M. Rosenow and John Y. S. Kim

-operative blood transfusion and operative time are quality indicators for pancreatoduodenectomy . HPB (Oxford) 12 : 465 – 471 , 2010 5 Baskett RJ , Buth KJ , Legaré JF , Hassan A , Hancock Friesen C , Hirsch GM , : Is it safe to train residents to perform cardiac surgery? . Ann Thorac Surg 74 : 1043 – 1049 , 2002 6 Boakye M , Patil CG , Ho C , Lad SP : Cervical corpectomy: complications and outcomes . Neurosurgery 63 : 4 Suppl 2 295 – 302 , 2008 7 Coates KW , Kuehl TJ , Bachofen CG , Shull BL : Analysis of surgical

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Anil K. Roy, Jason Chu, Caroline Bozeman, Samir Sarda, Michael Sawvel and Joshua J. Chern

T hirty-day readmission and reoperation rates have been used as quality indicators across surgical specialties. 1 , 2 , 4–6 , 8–12 , 14 This relatively long time interval (30 days) enables one to capture complications resulting from complex interplays among preoperative, intraoperative, and postoperative factors following the index surgery. For example, surgical infection could be a direct result of breaches of proper sterile technique, but it could also result from poor wound care or lack of access to medical care. Determining the relative contributions of

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Marcella Madera, Jeremy Brady, Sylvia Deily, Trent McGinty, Lee Moroz, Devender Singh, George Tipton and Eeric Truumees

data fields, including study quality indicators such as LOE and availability of accepted patient-reported outcomes measures. These findings were synthesized in a narrative format. Disagreements on the inclusion of a study were resolved by a third author (M.M.). In addition, we also performed manual searches of review bibliographies and reference lists of primary studies not captured by the electronic searches. To further avoid missing studies not referenced in our original papers' bibliographies or our literature searches, we sought additional recommendations from

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Chloe O’Connell, Tej Deepak Azad, Vaishali Mittal, Daniel Vail, Eli Johnson, Atman Desai, Eric Sun, John K. Ratliff and Anand Veeravagu

depression on opioid use following lumbar fusion, controlling for different levels of preoperative opioid use and other confounding variables. Secondarily, we examined whether patients with a preexisting diagnosis of depression have poorer overall lumbar fusion outcomes than the patients without depression. A variety of different quality indicator and economic outcomes were considered, including complications, 30-day all-cause readmissions, revision surgeries, discharge home, and 1- and 2-year costs. Methods Data Source To conduct this study, we queried an observational