A retrospective analysis of factors influencing readmission rates of acute traumatic subdural hematoma in the elderly: A cohort study

Abstract

Objective: Acute traumatic subdural hematomas (TSDH) readmission rate is high (27.8%) with an increase in morbidity and cost for the elderly. This study identifies risk factors affecting readmission rates for these patients and presents strategies to reduce it. Methods: A retrospective analysis was conducted including patients with TSDH admitted to our Community Hospital and followed subsequently for two years regarding readmission within 6 months of initial discharge. The following factors were compared for patients readmitted versus not readmitted: patient age, sex, number of comorbidities, anticoagulation status, surgical intervention, ICU length of stay, injury severity score, and discharge disposition. Results: A total of 167 patients were included in the study. Overall, 75 patients (44.9%) were readmitted within 6 months. Readmitted patients had an overall higher mean age (74.1 vs. 65.4, p = 0.001). Readmission with recurrent subdural hematoma was diagnosed in 32.2% of readmitted patients vs. 67.8% (p < 0.0005) with readmission for other medical complications. 80.0% of readmitted patients had more than four comorbid conditions (p < 0.0001). Conclusion: This study identifies risk factors that affect readmission rates for patients with TSDH and establishes strategies that may help to decrease readmission. Highlights:

Loss to Follow-up and Unplanned Readmission After Emergent Surgery for Acute Subdural Hematoma

“…Perhaps socioeconomic factors do not play as much of a role in aSDH readmission rates as they do for other disease processes. Ho et al 6 found a relationship between age and readmission after aSDH; however, they measured 6-month readmission rates instead of 90 days. Brito et al 3 found a relationship between age and readmission after traumatic brain injury, including but not limited to aSDH.…”

“…Based on the prior literature [3][4][5][6][7][8][9][10][11][12][13] and our univariate analyses (Supplementary Table 1, http://links.lww.com/NEU/D210), there were 10 factors potentially associated with either LTF or readmission: age, operation type, transfer status, distance from hospital, ADI, insurance, length of stay (LOS), mRS at discharge, number of comorbidities, and disposition. Owing to the limited number of patients who were LTF and/or readmitted, using all 10 factors in multivariable analysis was not a reasonable choice given the risk of model overfitting.…”

“…Several previous studies have examined the factors associated with unplanned readmission in patients with aSDH. 3-9 In addition, some studies have examined loss to follow-up (LTF) in neurosurgical populations. 10-13 No previous neurosurgical studies have evaluated the factors associated with LTF specifically in patients with aSDH or studied LTF side-by-side with unplanned readmission as similar postdischarge adverse outcomes.…”

Inpatient management of complicated mTBI with the BIG assessment tool: Review and summary of the evidence

“…Recurrence rates of patients with mild traumatic brain injury can be relatively high. 10,11 This has serious medical implications when the risk of delayed intracranial hemorrhage is of concern including that patients following complicated mild TBI (cmTBI) suffer long-term sequelae. 12,13 The accepted understanding that symptom resolution is considered indicative of recovery is being challenged and concerns that a normal test score does not necessarily indicate clinical recovery has been suggested recently.…”