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Cranial neurosurgical 30-day readmissions by clinical indication.
J Neurosurg 2015; 123(1):189-97JN

Abstract

OBJECT

Postsurgical readmissions are common and vary by procedure. They are significant drivers of increased expenditures in the health care system. Reducing readmissions is a national priority that has summoned significant effort and resources. Before the impact of quality improvement efforts can be measured, baseline procedure-related 30-day all-cause readmission rates are needed. The objects of this study were to determine population-level, 30-day, all-cause readmission rates for cranial neurosurgery and identify factors associated with readmission.

METHODS

The authors identified patient discharge records for cranial neurosurgery and their 30-day all-cause readmissions using the Agency for Healthcare Research and Quality (AHRQ) State Inpatient Databases for California, Florida, and New York. Patients were categorized into 4 groups representing procedure indication based on ICD-9-CM diagnosis codes. Logistic regression models were developed to identify patient characteristics associated with readmissions. The main outcome measure was unplanned inpatient admission within 30 days of discharge.

RESULTS

A total of 43,356 patients underwent cranial neurosurgery for neoplasm (44.23%), seizure (2.80%), vascular conditions (26.04%), and trauma (26.93%). Inpatient mortality was highest for vascular admissions (19.30%) and lowest for neoplasm admissions (1.87%; p < 0.001). Thirty-day readmissions were 17.27% for the neoplasm group, 13.89% for the seizure group, 23.89% for the vascular group, and 19.82% for the trauma group (p < 0.001). Significant predictors of 30-day readmission for neoplasm were Medicaid payer (OR 1.33, 95% CI 1.15-1.54) and fluid/electrolyte disorder (OR 1.44, 95% CI 1.29-1.62); for seizure, male sex (OR 1.74, 95% CI 1.17-2.60) and index admission through the emergency department (OR 2.22, 95% CI 1.45-3.43); for vascular, Medicare payer (OR 1.21, 95% CI 1.05-1.39) and renal failure (OR 1.52, 95% CI 1.29-1.80); and for trauma, congestive heart failure (OR 1.44, 95% CI 1.16-1.80) and coagulopathy (OR 1.51, 95% CI 1.25-1.84). Many readmissions had primary diagnoses identified by the AHRQ as potentially preventable.

CONCLUSIONS

The frequency of 30-day readmission rates for patients undergoing cranial neurosurgery varied by diagnosis between 14% and 24%. Important patient characteristics and comorbidities that were associated with an increased readmission risk were identified. Some hospital-level characteristics appeared to be associated with a decreased readmission risk. These baseline readmission rates can be used to inform future efforts in quality improvement and readmission reduction.

Authors+Show Affiliations

Stanford School of Medicine, Stanford, California.Departments of 2 Surgery and.Neurosurgery.Departments of 2 Surgery and.

Pub Type(s)

Journal Article
Observational Study
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

25658784

Citation

Moghavem, Nuriel, et al. "Cranial Neurosurgical 30-day Readmissions By Clinical Indication." Journal of Neurosurgery, vol. 123, no. 1, 2015, pp. 189-97.
Moghavem N, Morrison D, Ratliff JK, et al. Cranial neurosurgical 30-day readmissions by clinical indication. J Neurosurg. 2015;123(1):189-97.
Moghavem, N., Morrison, D., Ratliff, J. K., & Hernandez-Boussard, T. (2015). Cranial neurosurgical 30-day readmissions by clinical indication. Journal of Neurosurgery, 123(1), pp. 189-97. doi:10.3171/2014.12.JNS14447.
Moghavem N, et al. Cranial Neurosurgical 30-day Readmissions By Clinical Indication. J Neurosurg. 2015;123(1):189-97. PubMed PMID: 25658784.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cranial neurosurgical 30-day readmissions by clinical indication. AU - Moghavem,Nuriel, AU - Morrison,Doug, AU - Ratliff,John K, AU - Hernandez-Boussard,Tina, Y1 - 2015/02/06/ PY - 2015/2/7/entrez PY - 2015/2/7/pubmed PY - 2015/9/19/medline KW - NCHS = National Center for Health Statistics KW - PPACA = Patient Protection and Affordable Care Act KW - SID = State Inpatient Database KW - neurosurgery KW - outcomes KW - quality improvement KW - readmissions SP - 189 EP - 97 JF - Journal of neurosurgery JO - J. Neurosurg. VL - 123 IS - 1 N2 - OBJECT: Postsurgical readmissions are common and vary by procedure. They are significant drivers of increased expenditures in the health care system. Reducing readmissions is a national priority that has summoned significant effort and resources. Before the impact of quality improvement efforts can be measured, baseline procedure-related 30-day all-cause readmission rates are needed. The objects of this study were to determine population-level, 30-day, all-cause readmission rates for cranial neurosurgery and identify factors associated with readmission. METHODS: The authors identified patient discharge records for cranial neurosurgery and their 30-day all-cause readmissions using the Agency for Healthcare Research and Quality (AHRQ) State Inpatient Databases for California, Florida, and New York. Patients were categorized into 4 groups representing procedure indication based on ICD-9-CM diagnosis codes. Logistic regression models were developed to identify patient characteristics associated with readmissions. The main outcome measure was unplanned inpatient admission within 30 days of discharge. RESULTS: A total of 43,356 patients underwent cranial neurosurgery for neoplasm (44.23%), seizure (2.80%), vascular conditions (26.04%), and trauma (26.93%). Inpatient mortality was highest for vascular admissions (19.30%) and lowest for neoplasm admissions (1.87%; p < 0.001). Thirty-day readmissions were 17.27% for the neoplasm group, 13.89% for the seizure group, 23.89% for the vascular group, and 19.82% for the trauma group (p < 0.001). Significant predictors of 30-day readmission for neoplasm were Medicaid payer (OR 1.33, 95% CI 1.15-1.54) and fluid/electrolyte disorder (OR 1.44, 95% CI 1.29-1.62); for seizure, male sex (OR 1.74, 95% CI 1.17-2.60) and index admission through the emergency department (OR 2.22, 95% CI 1.45-3.43); for vascular, Medicare payer (OR 1.21, 95% CI 1.05-1.39) and renal failure (OR 1.52, 95% CI 1.29-1.80); and for trauma, congestive heart failure (OR 1.44, 95% CI 1.16-1.80) and coagulopathy (OR 1.51, 95% CI 1.25-1.84). Many readmissions had primary diagnoses identified by the AHRQ as potentially preventable. CONCLUSIONS: The frequency of 30-day readmission rates for patients undergoing cranial neurosurgery varied by diagnosis between 14% and 24%. Important patient characteristics and comorbidities that were associated with an increased readmission risk were identified. Some hospital-level characteristics appeared to be associated with a decreased readmission risk. These baseline readmission rates can be used to inform future efforts in quality improvement and readmission reduction. SN - 1933-0693 UR - https://www.unboundmedicine.com/medline/citation/25658784/Cranial_neurosurgical_30_day_readmissions_by_clinical_indication_ L2 - https://thejns.org/doi/10.3171/2014.12.JNS14447 DB - PRIME DP - Unbound Medicine ER -