Establishing risk-adjusted quality indicators in surgery using administrative data—an example from neurosurgery

Schipmann, Stephanie; Varghese, Julian; Brix, Tobias; Schwake, Michael; Keurhorst, Dennis; Lohmann, Sebastian; Molina, Eric Suero; Mauer, Uwe Max; Dugas, Martin; Warneke, Nils; Stummer, Walter

doi:10.1007/s00701-018-03792-2

Cited by 17 publications

(29 citation statements)

References 27 publications

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“…Other second diagnoses with implications on readmission are cerebral metastasis, congestive heart failure, peripheral arterial disease [ 15 , 19 ], myocardial infarction [ 13 ], hypertension [ 4 ], or coagulopathy [ 15 ]. In the literature, the number of side diagnoses correlates significantly with an increased risk of 30-day reoperations, readmissions, mortality, and infections [ 20 ], similar to the results presented here.…”

Section: Discussionsupporting

confidence: 87%

“…Specific strategies and definition of risk factors to prevent unplanned readmission for this patient cohort are needed [ 22 ]. The incomparability of the different health systems worldwide is additionally complicating this procedure in neurosurgical conditions [ 8 , 20 ]. Several datasets of neurosurgical patients from the USA are available [ 5 , 13 , 14 , 22 ], but there is only few information about readmission analysis in European and especially the German health care system [ 19 , 20 , 23 ].…”

Section: Introductionmentioning

confidence: 99%

“…The incomparability of the different health systems worldwide is additionally complicating this procedure in neurosurgical conditions [ 8 , 20 ]. Several datasets of neurosurgical patients from the USA are available [ 5 , 13 , 14 , 22 ], but there is only few information about readmission analysis in European and especially the German health care system [ 19 , 20 , 23 ]. In addition, with the growing availability of interventional treatment and the aging population, the amount of patients without surgical treatment, meaning conservative or interventional neurosurgical therapy, is increasing.…”

Section: Introductionmentioning

confidence: 99%

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Early unplanned readmission of neurosurgical patients after treatment of intracranial lesions: a comparison between surgical and non-surgical intervention group

et al. 2020

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Background Recent 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. 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 patients were divided into a surgical and a non-surgical group. The main outcome measure was unplanned inpatient admission within 30 days of discharge. Results During 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). Conclusions We 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.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Early unplanned readmission of neurosurgical patients after treatment of intracranial lesions: a comparison between surgical and non-surgical intervention group

et al. 2020

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“…In the current literature, the majority of studies and predictor analyses were done in North America on patients with spinal disorders in neurosurgery [7]. However, transfer of conclusions or deduction of these recommendations to a German cohort with national differences in health care and in cultural composition of the population is not permissible [8,9]. Only few publications of German spinal neurosurgical groups on this topic exist, and up to now, no study analyses the index diagnoses and the different surgical approaches in view of the 30-day readmission.…”

Section: Introductionmentioning

confidence: 99%

The Relation of Surgical Procedures And Diagnosis Groups To Unplanned Readmission In Spinal Neurosurgery. A Retrospective Single Center Study.

Sander

Oppermann

Nestler

et al. 2021

Preprint

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PurposeUnplanned readmission has gained increasing interest as a quality marker for inpatient care, as it is associated with patient mortality and higher economic costs. Spinal neurosurgery is characterized by a lack of epidemiologic readmission data. The aim of this study was to identify causes and predictors for unplanned readmissions related to index diagnoses and surgical procedures. MethodsIn this study from 2015-2017, spinal neurosurgical procedures were recorded. The main reasons for an unplanned readmission in between 30 days after discharge were identified. Multivariate logarithmic regression revealed predictors of unplanned readmission. Results1172 patient records were examined, of which 4.27 % disclosed unplanned readmissions. Among the surgical patients the readmission rate was 4.06 % mainly due to surgical site infections, for the non-surgical patients 5.06 % due to uncontrolled pain. A night-time surgery presented as independent predictive factor. ConclusionIn the heterogeneous group of spinal neurosurgical patients, stratification into diagnostic groups is necessary for statistical analysis. Degenerative lumbar spinal stenosis and spinal abscesses are mainly affected by unplanned readmission. The surgical procedure dorsal root ganglion stimulation is an independent predictor of unplanned re-hospitalizations, as is timing of surgery.

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“…8,9 However, administrative data have been shown to not reflect the endogenous patient risk. 10 Still, there is only little information about risk factors and methods for adequate risk adjustment to compare different healthcare providers. Building on the results of the first prospective study on outcome predictors in neurosurgery by Reponen et al, we aimed at developing a highquality clinical data registry with prospective data entry.…”

mentioning

confidence: 99%

Development and validation of prediction scores for nosocomial infections, reoperations, and adverse events in the daily clinical setting of neurosurgical patients with cerebral and spinal tumors

Lohmann¹,

Brix

Varghese

et al. 2021

Journal of Neurosurgery

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OBJECTIVEVarious quality indicators are currently under investigation, aiming at measuring the quality of care in neurosurgery; however, the discipline currently lacks practical scoring systems for accurately assessing risk. The aim of this study was to develop three accurate, easy-to-use risk scoring systems for nosocomial infections, reoperations, and adverse events for patients with cerebral and spinal tumors.METHODSThe authors developed a semiautomatic registry with administrative and clinical data and included all patients with spinal or cerebral tumors treated between September 2017 and May 2019. Patients were further divided into development and validation cohorts. Multivariable logistic regression models were used to develop risk scores by assigning points based on β coefficients, and internal validation of the scores was performed.RESULTSIn total, 1000 patients were included. An unplanned 30-day reoperation was observed in 6.8% of patients. Nosocomial infections were documented in 7.4% of cases and any adverse event in 14.5%. The risk scores comprise variables such as emergency admission, nursing care level, ECOG performance status, and inflammatory markers on admission. Three scoring systems, NoInfECT for predicting the incidence of nosocomial infections (low risk, 1.8%; intermediate risk, 8.1%; and high risk, 26.0% [p < 0.001]), LEUCut for 30-day unplanned reoperations (low risk, 2.2%; intermediate risk, 6.8%; and high risk, 13.5% [p < 0.001]), and LINC for any adverse events (low risk, 7.6%; intermediate risk, 15.7%; and high risk, 49.5% [p < 0.001]), showed satisfactory discrimination between the different outcome groups in receiver operating characteristic curve analysis (AUC ≥ 0.7).CONCLUSIONSThe proposed risk scores allow efficient prediction of the likelihood of adverse events, to compare quality of care between different providers, and further provide guidance to surgeons on how to allocate preoperative care.

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Establishing risk-adjusted quality indicators in surgery using administrative data—an example from neurosurgery

Cited by 17 publications

References 27 publications

Early unplanned readmission of neurosurgical patients after treatment of intracranial lesions: a comparison between surgical and non-surgical intervention group

Early unplanned readmission of neurosurgical patients after treatment of intracranial lesions: a comparison between surgical and non-surgical intervention group

The Relation of Surgical Procedures And Diagnosis Groups To Unplanned Readmission In Spinal Neurosurgery. A Retrospective Single Center Study.

Development and validation of prediction scores for nosocomial infections, reoperations, and adverse events in the daily clinical setting of neurosurgical patients with cerebral and spinal tumors

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