Incidence and predictors of 30-day readmission for patients discharged home after craniotomy for malignant supratentorial tumors in California (1995–2010)

Clinical article

Logan P. Marcus M.S.1, Brandon A. McCutcheon M.P.P.1, Abraham Noorbakhsh B.S.1, Ralitza P. Parina M.P.H.1, David D. Gonda M.D.2, Clark Chen M.D., Ph.D.2, David C. Chang Ph.D., M.P.H., M.B.A.1, and Bob S. Carter M.D., Ph.D.2
View More View Less
  • 1 Department of Surgery and
  • | 2 Division of Neurosurgery, University of California, San Diego, California
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online

Object

Hospital readmission within 30 days of discharge is a major contributor to the high cost of health care in the US and is also a major indicator of patient care quality. The purpose of this study was to investigate the incidence, causes, and predictors of 30-day readmission following craniotomy for malignant supratentorial tumor resection.

Methods

The longitudinal California Office of Statewide Health Planning & Development inpatient-discharge administrative database is a data set that consists of 100% of all inpatient hospitalizations within the state of California and allows each patient to be followed throughout multiple inpatient hospital stays, across multiple institutions, and over multiple years (from 1995 to 2010). This database was used to identify patients who underwent a craniotomy for resection of primary malignant brain tumors. Causes for unplanned 30-day readmission were identified by principle ICD-9 diagnosis code and multivariate analysis was used to determine the independent effect of various patient factors on 30-day readmissions.

Results

A total of 18,506 patients received a craniotomy for the treatment of primary malignant brain tumors within the state of California between 1995 and 2010. Four hundred ten patients (2.2%) died during the index surgical admission, 13,586 patients (73.4%) were discharged home, and 4510 patients (24.4%) were transferred to another facility. Among patients discharged home, 1790 patients (13.2%) were readmitted at least once within 30 days of discharge, with 27% of readmissions occurring at a different hospital than the initial surgical institution. The most common reasons for readmission were new onset seizure and convulsive disorder (20.9%), surgical infection of the CNS (14.5%), and new onset of a motor deficit (12.8%). Medi-Cal beneficiaries were at increased odds for readmission relative to privately insured patients (OR 1.52, 95% CI 1.20–1.93). Patients with a history of prior myocardial infarction were at an increased risk of readmission (OR 1.64, 95% CI 1.06–2.54) as were patients who developed hydrocephalus (OR 1.58, 95% CI 1.20–2.07) or venous complications during index surgical admission (OR 3.88, 95% CI 1.84–8.18).

Conclusions

Using administrative data, this study demonstrates a baseline glioma surgery 30-day readmission rate of 13.2% in California for patients who are initially discharged home. This paper highlights the medical histories, perioperative complications, and patient demographic groups that are at an increased risk for readmission within 30 days of home discharge. An analysis of conditions present on readmission that were not present at the index surgical admission, such as infection and seizures, suggests that some readmissions may be preventable. Discharge planning strategies aimed at reducing readmission rates in neurosurgical practice should focus on patient groups at high risk for readmission and comprehensive discharge planning protocols should be implemented to specifically target the mitigation of potentially preventable conditions that are highly associated with readmission.

Abbreviations used in this paper:

DVT = deep venous thrombosis; LOS = length of stay; OSHPD = Office of Statewide Health Planning & Development; PE = pulmonary embolism.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1

    Agency for Healthcare Research Quality: Re-engineered discharge project dramatically reduces return trips to the hospital Rockville, MD, Agency for Healthcare Research and Quality, 2011. (http://www.ahrq.gov/research/mar11/0311RA1.htm) [Accessed January 21, 2014]

    • Search Google Scholar
    • Export Citation
  • 2

    Barker FG II, , Curry WT Jr, & Carter BS: Surgery for primary supratentorial brain tumors in the United States, 1988 to 2000: the effect of provider caseload and centralization of care. Neuro Oncol 7:4963, 2005

    • Search Google Scholar
    • Export Citation
  • 3

    Centers for Medicare and Medicaid Services: Readmissions Reduction Program Baltimore, Centers for Medicare and Medicaid Services, 2013. (http://cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.html) [Accessed January 22, 2014]

    • Search Google Scholar
    • Export Citation
  • 4

    Curry WT Jr, , Carter BS, & Barker FG II: Racial, ethnic, and socioeconomic disparities in patient outcomes after craniotomy for tumor in adult patients in the United States, 1988–2004. Neurosurgery 66:427438, 2010

    • Search Google Scholar
    • Export Citation
  • 5

    Hannan EL, , Racz MJ, , Walford G, , Ryan TJ, , Isom OW, & Bennett E, et al.: Predictors of readmission for complications of coronary artery bypass graft surgery. JAMA 290:773780, 2003

    • Search Google Scholar
    • Export Citation
  • 6

    Hannan EL, , Zhong Y, , Lahey SJ, , Culliford AT, , Gold JP, & Smith CR, et al.: 30-day readmissions after coronary artery bypass graft surgery in New York state. JACC Cardiovasc Interv 4:569576, 2011

    • Search Google Scholar
    • Export Citation
  • 7

    Hansen LO, , Young RS, , Hinami K, , Leung A, & Williams MV: Interventions to reduce 30-day rehospitalization: a systematic review. Ann Intern Med 155:520528, 2011

    • Search Google Scholar
    • Export Citation
  • 8

    Hendren S, , Morris AM, , Zhang W, & Dimick J: Early discharge and hospital readmission after colectomy for cancer. Dis Colon Rectum 54:13621367, 2011

    • Search Google Scholar
    • Export Citation
  • 9

    Jack BW, , Chetty VK, , Anthony D, , Greenwald JL, , Sanchez GM, & Johnson AE, et al.: A reengineered hospital discharge program to decrease rehospitalization: a randomized trial. Ann Intern Med 150:178187, 2009

    • Search Google Scholar
    • Export Citation
  • 10

    Jencks SF, , Williams MV, & Coleman EA: Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med 360:14181428, 2009

    • Search Google Scholar
    • Export Citation
  • 11

    Kassin MT, , Owen RM, , Perez SD, , Leeds I, , Cox JC, & Schnier K, et al.: Risk factors for 30-day hospital readmission among general surgery patients. J Am Coll Surg 215:322330, 2012

    • Search Google Scholar
    • Export Citation
  • 12

    Koehler BE, , Richter KM, , Youngblood L, , Cohen BA, , Prengler ID, & Cheng D, et al.: Reduction of 30-day postdischarge hospital readmission or emergency department (ED) visit rates in high-risk elderly medical patients through delivery of a targeted care bundle. J Hosp Med 4:211218, 2009

    • Search Google Scholar
    • Export Citation
  • 13

    Nasir K, , Lin Z, , Bueno H, , Normand SL, , Drye EE, & Keenan PS, et al.: Is same-hospital readmission rate a good surrogate for all-hospital readmission rate?. Med Care 48:477481, 2010

    • Search Google Scholar
    • Export Citation
  • 14

    Patient Protection Affordable Care Act of 2010, Pub Law 111–148, 124 Stat. 127, Sec. 6301 (March 23, 2010) (http://www.gpo.gov/fdsys/pkg/PLAW-111publ148/pdf/PLAW-111publ148.pdf) [Accessed January 21, 2014]

  • 15

    Rau J: Medicare to penalize 2,217 hospitals for excess readmissions. Kaiser Health News August 13 2012. (http://www.kaiserhealthnews.org/stories/2012/august/13/medicare-hospitalsreadmissions-penalties.aspx) [Accessed January 14, 2014]

    • Search Google Scholar
    • Export Citation
  • 16

    Reddy DM, , Townsend CM Jr, , Kuo YF, , Freeman JL, , Goodwin JS, & Riall TS: Readmission after pancreatectomy for pancreatic cancer in Medicare patients. J Gastrointest Surg 13:19631975, 2009

    • Search Google Scholar
    • Export Citation
  • 17

    Romano PS, , Roos LL, & Jollis JG: Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: differing perspectives. J Clin Epidemiol 46:10751090, 1993

    • Search Google Scholar
    • Export Citation
  • 18

    Schneider EB, , Hyder O, , Brooke BS, , Efron J, , Cameron JL, & Edil BH, et al.: Patient readmission and mortality after colorectal surgery for colon cancer: impact of length of stay relative to other clinical factors. J Am Coll Surg 214:390399, 2012

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 737 235 17
Full Text Views 955 34 1
PDF Downloads 361 33 3
EPUB Downloads 0 0 0