Quality Indicators in Cranial Neurosurgery: Which Are Presently Substantiated? A Systematic Review

Schipmann, Stephanie; Schwake, Michael; Molina, Eric Suero; Roeder, N.; Steudel, Wolf-Ingo; Warneke, Nils; Stummer, Walter

doi:10.1016/j.wneu.2017.03.111

Cited by 28 publications

(39 citation statements)

References 29 publications

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“…A 2017 systematic review supports these observations, finding no evidence to suggest that a 30-day readmission rate is a suitable indicator for QOL in neurosurgery. 35 The analysis in the 2017 systematic review supports the argument that readmissions may in fact be a marker for a high standard of care rather than inappropriate care.…”

Section: Controversy In 30-day Readmission Rates As a Quality Indicatormentioning

confidence: 85%

“…Our unplanned readmission rate is comparable to those of other published studies evaluating all neurosurgical patients, with a range of 6.9%-11.8%. 11,16,26,35,36,39,40 An additional study evaluating a general neurosurgical cohort found a higher rate of readmission at 19.4%, though this cohort included only patients undergoing craniotomies and excluded spine procedures. 28 In keeping with our study, cranial pathologies had a higher rate of readmission than spine pathologies.…”

Section: Thirty-day Readmission Rates and Associated Factorsmentioning

confidence: 99%

“…Utilizing a 30-day readmission rate as an indicator for quality of neurosurgical care remains controversial. 14,35,36 In their paper, Joynt and Jha proposed 3 potential issues with the use of 30-day readmission rates as a metric of quality: 1) low rates of preventable readmissions within 30 days, 2) more targeted alternative policies that are likely to be effective in improving discharge planning and care coordination, and 3) potential consequences of hospital efforts to reduce readmissions, including decreasing quality of more pertinent quality-improvement initiatives, such as patient safety. 16 Furthermore, low rates of avoidable readmissions are often driven by factors beyond hospital control (including patient-and community-level factors) and may actually reflect improved QOL due to decreased mortality rates and improved access to hospital care.…”

Section: Controversy In 30-day Readmission Rates As a Quality Indicatormentioning

confidence: 99%

“…38 Nonetheless, several publications have called into question the validity of 30-day readmission rates used in other areas of medicine as a quality of care (QOL) metric in neurosurgical patients. 11,16,26,35,36,39,40 In order to improve generalizability, one systematic review recognized the need for more data from developed countries outside the US given the predominance of US publications to date. 10 Here, we perform a retrospective review of all adult neurosurgical patients admitted to a single Canadian neurosurgical academic center and who were discharged to home to assess for the all-cause 30-day readmission rate, unplanned 30-day readmission rate, and avoidable 30-day readmission rate.…”

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confidence: 99%

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Thirty-day readmission rate as a surrogate marker for quality of care in neurosurgical patients: a single-center Canadian experience

Wilson

Jack

Nataraj

et al. 2019

Journal of Neurosurgery

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OBJECTIVE Readmission to the hospital within 30 days of discharge is used as a surrogate marker for quality and value of care in the United States (US) healthcare system. Concern exists regarding the value of 30-day readmission as a quality of care metric in neurosurgical patients. Few studies have assessed 30-day readmission rates in neurosurgical patients outside the US. The authors performed a retrospective review of all adult neurosurgical patients admitted to a single Canadian neurosurgical academic center and who were discharged to home to assess for the all-cause 30-day readmission rate, unplanned 30-day readmission rate, and avoidable 30-day readmission rate. METHODS A retrospective review was performed assessing 30-day readmission rates after discharge to home in all neurosurgical patients admitted to a single academic neurosurgical center from January 1, 2011, to December 31, 2011. The primary outcomes included rates of all-cause, unplanned, and avoidable readmissions within 30 days of discharge. Secondary outcomes included factors associated with unplanned and avoidable 30-day readmissions. RESULTS A total of 184 of 950 patients (19.4%) were readmitted to the hospital within 30 days of discharge. One-hundred three patients (10.8%) were readmitted for an unplanned reason and 81 (8.5%) were readmitted for a planned or rescheduled operation. Only 19 readmissions (10%) were for a potentially avoidable reason. Univariate analysis identified factors associated with readmission for a complication or persistent/worsening symptom, including age (p = 0.009), length of stay (p = 0.007), general neurosurgery diagnosis (p < 0.001), cranial pathology (p < 0.001), intensive care unit (ICU) admission (p < 0.001), number of initial admission operations (p = 0.01), and shunt procedures (p < 0.001). Multivariate analysis identified predictive factors of readmission, including diagnosis (p = 0.002, OR 2.4, 95% CI 1.4-5.3), cranial pathology (p = 0.002, OR 2.7, 95% CI 1.4-5.3), ICU admission (p = 0.004, OR 2.4, 95% CI 1.3-4.2), and number of first admission operations (p = 0.01, OR 0.51, 95% CI 0.3-0.87). Univariate analysis performed to identify factors associated with potentially avoidable readmissions included length of stay (p = 0.03), diagnosis (p < 0.001), cranial pathology (p = 0.02), and shunt procedures (p < 0.001). Multivariate analysis identified only shunt procedures as a predictive factor for avoidable readmission (p = 0.02, OR 5.6, 95% CI 1.4-22.8). CONCLUSIONS Almost one-fifth of neurosurgical patients were readmitted within 30 days of discharge. However, only about half of these patients were admitted for an unplanned reason, and only 10% of all readmissions were potentially avoidable. This study demonstrates unique challenges encountered in a publicly funded healthcare setting and supports the growing literature suggesting 30-day readmission rates may serve as an inappropriate quality of care metric in neurosurgical patients. Potentially avoidable readmissions can be predicted, and further research assessi...

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Section: Controversy In 30-day Readmission Rates As a Quality Indicatormentioning

confidence: 85%

Section: Thirty-day Readmission Rates and Associated Factorsmentioning

confidence: 99%

Section: Controversy In 30-day Readmission Rates As a Quality Indicatormentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Thirty-day readmission rate as a surrogate marker for quality of care in neurosurgical patients: a single-center Canadian experience

Wilson

Jack

Nataraj

et al. 2019

Journal of Neurosurgery

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“…However, the controversy surrounding the use of these rates by HPPR to penalize hospitals has also invited scrutiny of 30-day readmission rates in neurological surgery as a health-care quality metric. [ 7 , 8 , 11 ]…”

Section: Introductionmentioning

confidence: 99%

Causes of hospital readmissions within 7 days from the neurosurgical service of a quaternary referral hospital

Nwachuku

Patel

Paul

et al. 2020

Surgical Neurology International

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Background: Evaluation of readmission rates as a proxy metric of health-care quality in neurological surgery has grown to become a prevalent area of investigation in the last several years. Significant attention has been paid to 30-day readmission rates due to the financial incentive to health-care providers following the enforcement of the penalties created by the Affordable Care Act. However, relatively little attention has been paid to patients readmitted within 7 days of discharge to large quaternary neurological surgery services. This study was conducted to examine the causes and unique characteristics of 7-day readmission rates from a neurosurgical service at a large quaternary referral hospital. Methods: A retrospective observational analysis of all 7-day readmissions to the neurosurgical surgery service of the University of Pittsburgh Medical Center, Presbyterian Hospital from August 2017 to June 2019, was performed. Patients were organized into seven categories based on their primary reason for readmission: scheduled surgeries, infection, pain, altered mental status or seizures, general postoperative complications, complications directly resulting from a neurosurgical intervention, and unrelated reasons. Demographic information, the time between initial discharge and subsequent readmission, and discharge disposition were also recorded. Results: Of 5274 discharges, 258 patients (4.9%) were readmitted within 7 days (55.0% male; mean age 60 years of age). Two-thirds of patients readmitted initially underwent care for cranial pathologies (57% of 258 patients) as opposed to a third for spine pathologies (33% of 258 patients). Complications that directly arose from the neurosurgical intervention (e.g., shunt infection or misplacement, and hardware misplacement) represented 18.9% of total readmission, while general postoperative complications (e.g., urinary tract infection) accounted for 15.1% of total readmission, in which all together were slightly greater than a third of readmissions. Seizures or altered mental status led to less than a fifth of readmissions (17.0%), followed by readmissions from unrelated diagnosis or miscellaneous reasons (17.0%) and scheduled surgeries (13.1%). Taken together, surgical site infections (9.7%) and postoperative pain (9.3%) accounted for 9.7% and 9.3 % of readmissions, respectively. Conclusion: Approximately 5% of patients discharged in a single year from our quaternary referral center were readmitted within 7-days. Approximately 90% of all 7-day readmissions were unplanned, with one-third resulting directly from perioperative complications. Further investigation to better understand this acutely vulnerable yet previously overlooked population may guide focused efforts to increase the quality of neurosurgical patient care.

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Adverse events in brain tumor surgery: incidence, type, and impact on current quality metrics

et al. 2019

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Quality Indicators in Cranial Neurosurgery: Which Are Presently Substantiated? A Systematic Review

Cited by 28 publications

References 29 publications

Thirty-day readmission rate as a surrogate marker for quality of care in neurosurgical patients: a single-center Canadian experience

Thirty-day readmission rate as a surrogate marker for quality of care in neurosurgical patients: a single-center Canadian experience

Causes of hospital readmissions within 7 days from the neurosurgical service of a quaternary referral hospital

Adverse events in brain tumor surgery: incidence, type, and impact on current quality metrics

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