Abstract
BackgroundRecent health care policy making has highlighted the necessity for understanding factors that influence readmission. To elucidate the rate, reason, and predictors of readmissions in neurosurgical patients, we analyzed unscheduled readmissions to our neurosurgical department after treatment for cranial or cerebral lesions.MethodsFrom 2015 to 2017, all adult patients who had been discharged from our Department of Neurosurgery and were readmitted within 30 days were included into the study cohort. The patients were divided into a surgical and a non-surgical group. The main outcome measure was unplanned inpatient admission within 30 days of discharge.ResultsDuring the observation period, 183 (7.4%) of 2486 patients had to be readmitted unexpectedly within 30 days after discharge. The main readmission causes were surgical site infection (34.4 %) and seizure (16.4%) in the surgical group, compared to natural progression of the original diagnosis (38.2%) in the non-surgical group. Most important predictors for an unplanned readmission were younger age, presence of malignoma (OR: 2.44), and presence of cardiovascular side diagnoses in the surgical group. In the non-surgical group, predictors were length of stay (OR: 1.07) and the need for intensive care (OR: 5.79).ConclusionsWe demonstrated that reasons for readmission vary between operated and non-operated patients and are preventable in large numbers. In addition, we identified treatment-related partly modifiable factors as predictors of unplanned readmission in the non-surgical group, while unmodifiable patient-related factors predominated in the surgical group. Further patient-related risk adjustment models are needed to establish an individualized preventive strategy in order to reduce unplanned readmissions.
Highlights
Readmission has emerged as a surrogate marker for assessing the quality of hospitals
Four categories of readmission were defined: (1) preventable reasons (e.g., SSI, Cerebrospinal fluid (CSF) leak, postoperative hemorrhage, nosocomial infection, postoperative pain, falls), (2) reasons related to the natural progression of the disease, (3) reasons despite best practice (e. g., stroke, new neurological symptoms), and (4) unrelated reasons according to the study by Shah et al [22]
The surgical study group showed a significantly higher case severity measured by Patient clinical complexity level (PCCL), longer length of stay (LOS), and increased number of second diagnoses in comparison to the non-surgical/interventional group
Summary
Readmission has emerged as a surrogate marker for assessing the quality of hospitals. Since financial hospital reimbursement policies are becoming more important, identifying risk factors for unplanned readmissions is of crucial interest [2, 24]. From a medical point of view far more important than economic reasons, the focus lies on defining patient groups at risk, to help in the development of preventive strategies and to increase patient safety and satisfaction [1, 6, 12]. Thirty-day hospital readmission is a marker associated to short-term complications and is often employed by health care politicians for outcome measurements [3]. Methods From 2015 to 2017, all adult patients who had been discharged from our Department of Neurosurgery and were readmitted within 30 days were included into the study cohort. The main outcome measure was unplanned inpatient admission within 30 days of discharge
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