Incidence and predictors of 30-day readmission for patients discharged home after craniotomy for malignant supratentorial tumors in California (1995–2010)

Abstract

Using administrative data, this study demonstrates a baseline glioma surgery 30-day readmission rate of 13.2% in California for patients who are initially discharged home. This paper highlights the medical histories, perioperative complications, and patient demographic groups that are at an increased risk for readmission within 30 days of home discharge. An analysis of conditions present on readmission that were not present at the index surgical admission, such as infection and seizures, suggests that some readmissions may be preventable. Discharge planning strategies aimed at reducing readmission rates in neurosurgical practice should focus on patient groups at high risk for readmission and comprehensive discharge planning protocols should be implemented to specifically target the mitigation of potentially preventable conditions that are highly associated with readmission.

Causes of 30-day readmission after neurosurgery of the spine

“…21,24 Other studies reporting on the neurosurgery of the spine show varying results as well. 5,6,25,31,32,36,38 Three studies investigated ASA physical status classification and found it to be significantly elevated in the readmitted group. 21,24,30 Previously, the increasing ASA score has been connected to increased mortality and worse outcomes for several surgical procedures by Wolters et al 39 Comorbid illnesses were also an effective predictor of readmission.…”

“…21,24,30 This conclusion is not at all surprising, as studies usually have shown a significant association between diabetes or hypertension and poor postoperative improvement for various procedures. 3,4,7,15,25,35 Diabetes and other comorbid conditions have also been noted as causes of a prolonged in-hospital stay, 4 explaining why Jansson et al 19 and Pugely et al 30 found extended LOS to be predictive of worse outcome.…”

“…21 Similarly, after craniotomy, patients who developed venous complications or hydrocephalus were nearly 4 times and 58%, respectively, more likely to return. 25 Eisenring et al, 9 as a result of their study, recommend using intraoperative leg elevation, intermittent pneumatic compression, early heparin administration, and low molecular weight heparin to reduce the risk for PE after skull base meningioma surgery. Pharmacological prophylaxis is recommended when surgically treating spinal cord injury; however, conclusive results are not available regarding degenerative spine surgery.…”

Letter to the Editor: Readmission

“…10 Indeed, there are some reports corroborating these findings and suggesting that steroids produce a hypercoagulable state in patients. 4,11,12 Since the landmark report of Galicich et al in 1961, high-dose corticosteroids are routinely administered to patients undergoing cranial surgery. 7,9 More recently, a renewed interest in the use of corticosteroids for both the medical treatment and perioperative medical treatment of chronic subdural hematoma (CSDH) has been sparked.…”

“…In the study by Marcus et al, 4 which utilized a statewide database to examine readmissions after supratentorial tumor resection (n = 18,506), they found that seizure was a main cause of readmission based on readmission ICD-9 codes. Do the authors have enough confidence in the validity of seizure diagnoses in this kind of database to recommend targeted prospective intervention?…”