Predictors of 30- and 90-day readmission following craniotomy for malignant brain tumors: analysis of nationwide data

Abstract

Hospital readmissions are a major contributor to increased health care costs and are associated with worse patient outcomes after neurosurgery. We used the newly released Nationwide Readmissions Database (NRD) to describe the association between patient, hospital and payer factors with 30- and 90-day readmission following craniotomy for malignant brain tumor. All adult inpatients undergoing craniotomy for primary and secondary malignant brain tumors in the NRD from 2013 to 2014 were included. We identified all cause readmissions within 30- and 90-days following craniotomy for tumor, excluding scheduled chemotherapeutic procedures. We used univariate and multivariate models to identify patient, hospital and administrative factors associated with readmission. We identified 27,717 admissions for brain tumor craniotomy in 2013-2014, with 3343 (13.2%) 30-day and 5271 (25.7%) 90-day readmissions. In multivariate analysis, patients with Medicaid and Medicare were more likely to be readmitted at 30- and 90-days compared to privately insured patients. Patients with two or more comorbidities were more likely to be readmitted at 30- and 90-days, and patients discharged to skilled nursing facilities or home health care were associated with increased 90-day readmission rates. Finally, hospital procedural volume above the 75th percentile was associated with decreased 90-day readmission rates. Patients treated at high volume hospitals are less likely to be readmitted at 90-days. Insurance type, non-routine discharge and patient comorbidities are predictors of postoperative non-scheduled readmission. Further studies may elucidate potentially modifiable risk factors when attempting to improve outcomes and reduce cost associated with brain tumor surgery.

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

“…Main predictors for an unplanned 30-day readmission in the surgical group were a higher number of side diagnoses (> 3), presence of certain secondary diseases, and patient age, while the presence of a malignant tumor as side diagnosis showed a highly significant impact in both study groups. This is in good accordance with most comparable studies [7,13,15]. 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. In the present study population, further reported patient characteristics such as male gender [4], type of health insurance [7], income [17], or race [15] were not confirmed. In the non-surgical group, we identified mainly treatment-related factors to be predictive for 30-day readmission, such as longer LOS and the need for ICU treatment.…”

Readmission after neurosurgical intervention in epilepsy: A nationwide cohort analysis

“…Single neurosurgical centers have found overall readmission rates nearing 10%, with most predictors of readmissions seen secondary to postoperative care complications . Larger studies have looked at 30‐day readmissions according to neurosurgical specialties such as post cranial tumor resection, spine surgery, or stroke‐related surgery using statewide or nationwide databases with varying 30‐day readmission rates . However, within this body of literature, those related to surgery in persons with epilepsy remain limited.…”

Predictors of Venous Thromboembolism After Nonemergent Craniotomy: A Nationwide Readmission Database Analysis

“…NRD is a pooled database of hospital admissions from numerous contributing states, in which patients are assigned unique linkage numbers that effectively allows them to be tracked for subsequent readmission. It has previously been employed in the literature to analyze readmission patterns for various neurosurgical pathologies [19][20][21][22] . The goals of this investigation were: (1) to estimate VTE incidence among patients undergoing non-emergent craniotomy, and (2) to identify patient and hospital factors associated with VTE in order to establish high-risk features that could warrant early anticoagulation use.…”