Abstract
The purpose of this study was to critically analyze the risk of unplanned readmission following resection of brain metastasis and to identify key risk factors to allow for early intervention strategies in high-risk patients. We analyzed data from the Nationwide Readmissions Database (NRD) from 2010–2014, and included patients who underwent craniotomy for brain metastasis, identified using ICD-9-CM diagnosis (198.3) and procedure (01.59) codes. The primary outcome of the study was unplanned 30-day all-cause readmission rate. Secondary outcomes included reasons and costs of readmissions. Hierarchical logistic regression model was used to identify the factors associated with 30-day readmission following craniotomy for brain metastasis. During the study period, 44,846 index hospitalizations occurred for patients who underwent resection of brain metastasis. In this cohort, 17.8% (n = 7,965) had unplanned readmissions within the first 30 days after discharge from the index hospitalization. The readmission rate did not change significantly during the five-year study period (p-trend = 0.286). The median per-patient cost for 30-day unplanned readmission was $11,109 and this amounted to a total of $26.4 million per year, which extrapolates to a national expenditure of $269.6 million. Increasing age, male sex, insurance status, Elixhauser comorbidity index, length of stay, teaching status of the hospital, neurological complications and infectious complications were associated with 30-day readmission following discharge after an index admission for craniotomy for brain metastasis. Unplanned readmission rates after resection of brain metastasis remain high and involve substantial healthcare expenditures. Developing tools and interventions to prevent avoidable readmissions could focus on the high-risk patients as a future strategy to decrease substantial healthcare expense.
Highlights
10–30% of cancer patients develop brain metastasis during the course of their systemic disease, resulting in over 200,000 cases diagnosed annually in the United States[1]
As a result of this program, hospitals are penalized for increased rates of risk-standardized 30-day readmissions for pre-determined conditions, such as acute myocardial infarction, total hip and knee arthroplasty, chronic obstructive pulmonary disorder, and heart failure, with other conditions likely added in the future
We used hierarchical logistic regression model to identify the factors associated with 30-day readmission following craniotomy for brain metastasis since it accounts for the effect of nesting, where patient-level effects are nested with hospitallevel effects
Summary
10–30% of cancer patients develop brain metastasis during the course of their systemic disease, resulting in over 200,000 cases diagnosed annually in the United States[1]. By establishing the factors that make hospital readmissions preventable after neurosurgical procedures, risk management for craniotomies will improve patient care while mitigating the related financial cost of the hospital readmission care[4]. In an effort to decrease unplanned readmission rates for selected medical and surgical conditions, the Centers of Medicare & Medicaid Services (CMS) established the Hospital Readmissions Reduction Program (HRRP) within the Affordable Care Act in 2 0125. Substantial studies on factors associated with readmission rates after craniotomy are yet unpublished Understanding these elements could help lower readmission rates, reduce healthcare costs, as well as improve the quality of life of brain metastasis patients. The objective of this study was to develop a risk model for predicting 30-day unplanned readmission rates after surgical treatment of brain metastasis
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
