Postsurgical readmissions are common and vary by procedure. They are significant drivers of increased expenditures in the health care system. Reducing readmissions is a national priority that has summoned significant effort and resources. Before the impact of quality improvement efforts can be measured, baseline procedure-related 30-day all-cause readmission rates are needed. The objects of this study were to determine population-level, 30-day, all-cause readmission rates for cranial neurosurgery and identify factors associated with readmission.
The authors identified patient discharge records for cranial neurosurgery and their 30-day all-cause readmissions using the Agency for Healthcare Research and Quality (AHRQ) State Inpatient Databases for California, Florida, and New York. Patients were categorized into 4 groups representing procedure indication based on ICD-9-CM diagnosis codes. Logistic regression models were developed to identify patient characteristics associated with readmissions. The main outcome measure was unplanned inpatient admission within 30 days of discharge.
A total of 43,356 patients underwent cranial neurosurgery for neoplasm (44.23%), seizure (2.80%), vascular conditions (26.04%), and trauma (26.93%). Inpatient mortality was highest for vascular admissions (19.30%) and lowest for neoplasm admissions (1.87%; p < 0.001). Thirty-day readmissions were 17.27% for the neoplasm group, 13.89% for the seizure group, 23.89% for the vascular group, and 19.82% for the trauma group (p < 0.001). Significant predictors of 30-day readmission for neoplasm were Medicaid payer (OR 1.33, 95% CI 1.15–1.54) and fluid/electrolyte disorder (OR 1.44, 95% CI 1.29–1.62); for seizure, male sex (OR 1.74, 95% CI 1.17–2.60) and index admission through the emergency department (OR 2.22, 95% CI 1.45–3.43); for vascular, Medicare payer (OR 1.21, 95% CI 1.05–1.39) and renal failure (OR 1.52, 95% CI 1.29–1.80); and for trauma, congestive heart failure (OR 1.44, 95% CI 1.16–1.80) and coagulopathy (OR 1.51, 95% CI 1.25–1.84). Many readmissions had primary diagnoses identified by the AHRQ as potentially preventable.
The frequency of 30-day readmission rates for patients undergoing cranial neurosurgery varied by diagnosis between 14% and 24%. Important patient characteristics and comorbidities that were associated with an increased readmission risk were identified. Some hospital-level characteristics appeared to be associated with a decreased readmission risk. These baseline readmission rates can be used to inform future efforts in quality improvement and readmission reduction.
NCHS = National Center for Health Statistics; PPACA = Patient Protection and Affordable Care Act; SID = State Inpatient Database.
Correspondence Tina Hernandez-Boussard, Stanford School of Medicine, Department of Surgery, 1070 Arastradero #307, Palo Alto, CA 94305. email: firstname.lastname@example.org.
INCLUDE WHEN CITING Published online February 6, 2015; DOI: 10.3171/2014.12.JNS14447.
DISCLOSURE The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. Mr. Moghavem was supported by the Stanford School of Medicine Medical Scholars Fund. Dr. Hernandez-Boussard was supported by Grant No. K01 HS018558 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.
CooperRB: Inequality is at the Core of High Health Care Spending: A View From the OECD. Health Affairs Blog(http://healthaffairs.org/blog/2013/10/09/inequality-is-at-thecore-of-high-health-care-spending-a-view-from-the-oecd/) [Accessed December 2, 2014])| false
HernandezAF, , GreinerMA, , FonarowGC, , HammillBG, , HeidenreichPA, & YancyCW, et al.: Relationship between early physician follow-up and 30-day readmission among Medicare beneficiaries hospitalized for heart failure. JAMA303:1716–1722, 2010
HernandezAF, GreinerMA, FonarowGC, HammillBG, HeidenreichPA, YancyCW, : Relationship between early physician follow-up and 30-day readmission among Medicare beneficiaries hospitalized for heart failure. JAMA303:1716–1722, 2010)| false
LawsonEH, , HallBL, , LouieR, , EttnerSL, , ZingmondDS, & HanL, et al.: Association between occurrence of a postoperative complication and readmission: implications for quality improvement and cost savings. Ann Surg258:10–18, 2013
LawsonEH, HallBL, LouieR, EttnerSL, ZingmondDS, HanL, : Association between occurrence of a postoperative complication and readmission: implications for quality improvement and cost savings. Ann Surg258:10–18, 2013)| false
National Center for Health Statistics: 2006 Urban-Rural Classification Scheme for Counties. Centers for Disease Control and Prevention(http://www.cdc.gov/nchs/data_access/urban_rural.htm#counties2006) [Accessed December 2, 2014])| false
RosenAK, , LovelandS, , ShinM, , ShwartzM, , HanchateA, & ChenQ, et al.: Examining the impact of the AHRQ Patient Safety Indicators (PSIs) on the Veterans Health Administration: the case of readmissions. Med Care51:37–44, 2013
RosenAK, LovelandS, ShinM, ShwartzM, HanchateA, ChenQ, : Examining the impact of the AHRQ Patient Safety Indicators (PSIs) on the Veterans Health Administration: the case of readmissions. Med Care51:37–44, 2013)| false
WangMC, , ShivakotiM, , SparapaniRA, , GuoC, , LaudPW, & NattingerAB: Thirty-day readmissions after elective spine surgery for degenerative conditions among US Medicare beneficiaries. Spine J12:902–911, 2012
WangMC, ShivakotiM, SparapaniRA, GuoC, LaudPW, NattingerAB: Thirty-day readmissions after elective spine surgery for degenerative conditions among US Medicare beneficiaries. Spine J12:902–911, 2012)| false