A propensity score analysis of the impact of surgical intervention on unexpected 30-day readmission following admission for subdural hematoma

Franko, Lynze R.; Sheehan, Kyle M.; Roark, Christopher; Joseph, Jacob R.; Burke, James F.; Rajajee, Venkatakrishna; Williamson, Craig A.

doi:10.3171/2017.6.jns17188

Cited by 12 publications

(5 citation statements)

References 33 publications

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“…Therefore, 87 studies met the eligibility criteria and were included in this analysis (Fig. 1) [16–102]. The κ value for agreement on full text was excellent (0.90, p <0.01).…”

Section: Resultsmentioning

confidence: 99%

Hospital re‐admission after critical care survival: a systematic review and meta‐analysis

et al. 2021

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Summary Survivors of critical illness frequently require increased healthcare resources after hospital discharge. We undertook a systematic review and meta‐analysis to assess hospital re‐admission rates following critical care admission and to explore potential re‐admission risk factors. We searched the MEDLINE, Embase and CINAHL databases on 05 March 2020. Our search strategy incorporated controlled vocabulary and text words for hospital re‐admission and critical illness, limited to the English language. Two reviewers independently applied eligibility criteria and assessed quality using the Newcastle Ottawa Score checklist and extracted data. The primary outcome was acute hospital re‐admission in the year after critical care discharge. Of the 8851 studies screened, 87 met inclusion criteria and 41 were used within the meta‐analysis. The analysis incorporated data from 3,897,597 patients and 741,664 re‐admission episodes. Pooled estimates for hospital re‐admission after critical illness were 16.9% (95%CI: 13.3–21.2%) at 30 days; 31.0% (95%CI: 24.3–38.6%) at 90 days; 29.6% (95%CI: 24.5–35.2%) at six months; and 53.3% (95%CI: 44.4–62.0%) at 12 months. Significant heterogeneity was observed across included studies. Three risk factors were associated with excess acute care rehospitalisation one year after discharge: the presence of comorbidities; events during initial hospitalisation (e.g. the presence of delirium and duration of mechanical ventilation); and subsequent infection after hospital discharge. Hospital re‐admission is common in survivors of critical illness. Careful attention to the management of pre‐existing comorbidities during transitions of care may help reduce healthcare utilisation after critical care discharge. Future research should determine if targeted interventions for at‐risk critical care survivors can reduce the risk of subsequent rehospitalisation.

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“…Therefore, 87 studies met the eligibility criteria and were included in this analysis (Fig. 1) [16–102]. The κ value for agreement on full text was excellent (0.90, p <0.01).…”

Section: Resultsmentioning

confidence: 99%

Hospital re‐admission after critical care survival: a systematic review and meta‐analysis

et al. 2021

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“…While the mFI-11 is the most commonly used frailty measure in the literature, to date, no study has examined the mFI-11 or mFI-5 among patients with cSDH; an effect that may reflect a publication bias. Furthermore, while there have been previous studies investigating the relationship between the CCI and cSDH prognosis, there are conflicting results with some finding that the CCI is independently associated with cSDH recurrence [ 23 ], increased complications [ 24 , 25 ] and long-term mortality [ 26 ], while others have shown no such effects [ 2 , 27 ]. Differences in these studies may be attributed to inclusion criteria, with some groups, including our own, examining all cSDH patients, while others only examined certain types of operative patients.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Frailty versus Initial Glasgow Coma Score in Predicting Outcomes Following Chronic Subdural Hemorrhage: A Preliminary Analysis

McIntyre

Rawanduzy

Afridi

et al. 2020

Cureus

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Background Initial Glasgow Coma Score (iGCS) is a well-known predictor of adverse outcomes following chronic subdural hemorrhage (cSDH). Frailty, i.e. a reduced physiologic reserve, is associated with poorer outcomes across the surgical literature, however, there is no consensus on the best measure of frailty. To date, no study has compared frailty’s ability to predict cSDH outcomes versus iGCS. The goal of this study was to, therefore, examine the prognostic value of the 5- (mFI-5) and 11-factor (mFI-11) modified frailty index, and Charlson Comorbidity Index (CCI) versus iGCS following cSDH. Methods Between January, 2016 and June, 2018, patients who presented to the emergency department with cSDH were retrospectively identified using the International Classification of Diseases (ICD) codes. mFI-5, mFI-11, and CCI scores were calculated using patient baseline characteristics. Primary endpoints were death and discharge home and subgroup analyses were performed among operative cSDH. Univariate and multivariate logistic regressions were used to determine predictors of primary endpoints. Results Of the 109 patients identified, the average age was 72.6±1.6 years and the majority (69/109, 63.3%) were male. The average CCI, mFI-5, and mFI-11 were 4.5 ±0.2, 1.5 ±0.1, and 2.2 ±0.1, respectively. Fifty (45.9%) patients required surgical intervention, 11 (10.1%) died, and 48 (43.4%) were discharged home. In the overall cohort, while the only multivariate predictor of mortality was iGCS (OR=0.58; 95%CI:0.44-0.77; p=0.0001), the CCI (OR=0.73; 95%CI:0.58-0.92; p=0.0082) was a superior predictor of discharge home compared to iGCS (OR=1.46; 95%CI:1.13-1.90; p=0.0041). Conversely, among those who received an operative intervention, the CCI, but not iGCS, independently predicted both mortality (OR=4.24; 95%CI:1.01-17.86; p=0.0491) and discharge home (OR=0.55; 95%CI:0.33-0.90; p=0.0170). Neither mFI nor age predicted primary outcomes in multivariate analysis. Conclusion While frailty is associated with worse surgical outcomes, the clinical utility of the mFI-5, mFI-11, and CCI in cSDH is unclear. We show that the iGCS is an overall superior predictor of mortality following cSDH but is outperformed by the CCI after operative intervention. Similarly, the CCI is the superior predictor of discharge home in cSDH patients overall and following an operative intervention. These results indicate that while the iGCS best predicts mortality overall, the CCI may be considered when prognosticating post-operative course and hospital disposition.

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“…1 Although studies have examined patient hospital readmission for recurrence after surgical evacuation of nontraumatic subdural hematomas (SDHs), few have examined underlying causes of readmission. 2-4…”

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confidence: 99%

Nationwide Readmission Rates and Hospital Charges for Patients With Surgical Evacuation of Nontraumatic Subdural Hematomas: Part 1—Craniotomy

et al. 2022

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BACKGROUND: Despite patients experiencing high recurrence and readmission rates after surgical management of nontraumatic subdural hematomas (SDHs), few studies have examined the causes and predictors of unplanned readmissions in this population on a national scale. OBJECTIVE: To analyze independent factors predicting 30-day hospital readmissions after surgical treatment of nontraumatic SDH in patients who survived their index surgery and evaluate hospital readmission rates and charges. METHODS: Using the Nationwide Readmissions Database, we identified patients who underwent craniotomy for nontraumatic SDH evacuation (2010-2015) using a retrospective cohort observational study design. National estimates and variances within the cohort were calculated after stratifying, hospital clustering, and weighting variables. RESULTS: Among 49 013 patients, 10 643 (21.7%) had at least 1 readmission within 30 days of their index treatment and 38 370 (78.3%) were not readmitted. Annual readmission rates did not change during the study period (P = .74). The most common primary causes of 30-day readmissions were recurrent SDH (n = 3949, 37.1%), venous thromboembolism (n = 1373, 12.9%), and delayed hyponatremia and syndrome of inappropriate antidiuretic hormone secretion (n = 1363, 12.8%). Comorbidities that independently predicted readmission included congestive heart failure, chronic obstructive pulmonary disease, coagulopathy, diabetes mellitus, liver disease, lymphoma, fluid and electrolyte disorders, metastatic cancer, peripheral vascular disease, psychosis, and renal failure (P ≤ .03). Household income in the 51st to 75th percentile was associated with a decreased risk of readmission. CONCLUSION: National trends in 30-day readmission rates after nontraumatic SDH treatment by craniotomy provide quality benchmarks that can be used to drive quality improvement efforts on a national level.

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A propensity score analysis of the impact of surgical intervention on unexpected 30-day readmission following admission for subdural hematoma

Cited by 12 publications

References 33 publications

Hospital re‐admission after critical care survival: a systematic review and meta‐analysis

Hospital re‐admission after critical care survival: a systematic review and meta‐analysis

The Effect of Frailty versus Initial Glasgow Coma Score in Predicting Outcomes Following Chronic Subdural Hemorrhage: A Preliminary Analysis

Nationwide Readmission Rates and Hospital Charges for Patients With Surgical Evacuation of Nontraumatic Subdural Hematomas: Part 1—Craniotomy

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