Smoking and Obesity are Risk Factors for Thirty-Day Readmissions Following Skull Base Surgery

Abstract

Background Thirty-day readmission has become a significant health care metric reflecting the quality of care and on the cost of service delivery. There is little data on the impact of complications following skull base surgery (SBS) on emergency readmission. Identifying modifiable risk factors for readmission may improve care and reduce cost. Design The study was designed as a single-center retrospective cohort study. Methods Records for a consecutive series of 165 patients who underwent open or endoscopic SBS by a single surgeon reviewed. Patients with pituitary adenoma were excluded. The diagnosis, procedure, complications, length of stay (LOS), body mass index (BMI), and smoking status were recorded. Readmission to the neurosurgical department or regional hospitals was either noted prospectively or the patient contacted. Cause and length of readmission was documented. Results Of the 165 cases, 14 (8.5%) were readmitted within 30 days. Causes for readmission included cerebrospinal fluid (CSF) leak in 5/14 or 35.7% (overall rate for readmission for this complication in the series is 3.1%), infection in 4/14 (28.6%), hyponatraemia in 2/14 (14.3%), vascular: sinus thrombosis in 1/14 (7.1%), seizures in 1/14 (7.1%), and epistaxis in 1/14 (7.1%). Initial and readmission LOS was 6 and 14 days, respectively. BMI was higher in those readmitted within 30 days (33.2 kg/m2) versus no readmission (27.1 kg/m2). In addition, of those readmitted within 30 days, 35.7% were smokers compared with 20.8% in those not readmitted. Conclusion In this series, smoking and raised BMI may be indicators for within 30-day readmission and complications in this population, raising the question of risk factor modification prior to elective intervention.

Risk Factors for 30-day and 90-day Readmission After Lumbar Decompression

“…After accounting for these differences using multivariate regression, our study isolated several independent risk factors for readmission or complication following lumbar decompression. Similar to numerous other studies in the orthopedic literature, smoking was found to be an independent risk factor for surgical complication or hospital readmission 36–42 . While this does not represent an unexpected finding, it does provide further support to clinicians when counseling patients on the adverse impact of smoking in the setting of lumbar decompression surgery.…”

“…Similar to numerous other studies in the orthopedic literature, smoking was found to be an independent risk factor for surgical complication or hospital readmission. [36][37][38][39][40][41][42] While this does not represent an unexpected finding, it does provide further support to clinicians when counseling patients on the adverse impact of smoking in the setting of lumbar decompression surgery. Renal failure was also a significant predictor of hospital readmission or complication, consistent with prior studies.…”

“…[33][34][35] While previous studies have evaluated risk-factors for hospital readmission following spine surgery, there remains a paucity of literature evaluating specific predictors of readmission, evaluating both the 30-and 90-day postoperative period, after lumbar decompression. [36][37][38][39][40][41] The goal of this study was to determine risk factors for 30-and 90-day readmission after one-to four-level lumbar decompression at a single institution. Our analysis found several significant differences between readmission groups with regard to demographics and comorbidities.…”

A Comprehensive Analysis of Tobacco Smoking History as a Risk for Outcomes after Endoscopic Transsphenoidal Resection of Pituitary Adenoma

“…Although they excluded patients with pituitary adenomas in their analyses, Makwana et al reported that in their patients who underwent both endoscopic and open skull base surgery, smoking was associated with 30day readmissions and complications and this effect was independent of the number of pack-years of smoking. 15 In another study of the 2016 and 2017 National Readmission Database, Shahrestani, et al…”

Discontinuation of Postoperative Prophylactic Antibiotics for Endoscopic Endonasal Skull Base Surgery

“…18 The post-protocol group also had a statistically higher percentage of smokers, which is a known risk factor for postoperative infections and readmission rates in the neurosurgical population. [19][20][21]…”