Clinical Risk Factors and Postoperative Complications Associated with Unplanned Hospital Readmissions After Cranial Neurosurgery

Ramos, Christian Lopez; Brandel, Michael G.; Rennert, Robert C.; Wali, Arvin R.; Steinberg, Jeffrey A.; Santiago-Dieppa, David R; Burton, Brittany N.; Pannell, J. Scott; Olson, Scott; Khalessi, Alexander A.

doi:10.1016/j.wneu.2018.07.136

Cited by 20 publications

(14 citation statements)

References 29 publications

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“…Prior studies have identified preoperative anemia as a predictor of postoperative complications, prolonged length of stay, and readmission rates in neurosurgical procedures. 12,13 Spine literature also has included preoperative anemia as a modifiable risk factor to reduce complications and optimize recovery. [14][15][16] They have found that preoperative anemia is an independent risk factor for complications and prolonged lengths of stay in lumbar fusions, posterior cervical fusions, and deformity surgery.…”

Section: Non-neurological Morbiditymentioning

confidence: 99%

Risk Factors for 30-Day Non-Neurological Morbidity and Cerebrospinal Fluid Leak in Patients Undergoing Surgery for Vestibular Schwannoma

Gelfand

Longo

Berezin

et al. 2019

J Neurol Surg B Skull Base

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Introduction We analyzed perioperative risk factors for morbidity and mortality for the patients undergoing surgical intervention for vestibular schwannoma along with rates of cerebrospinal fluid (CSF) leaks that required surgery. Materials and Methods Patients undergoing surgery vestibular schwannoma were identified in the American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2016 using current procedural terminology (CPT) codes for posterior fossa surgical approaches and International Classification of Diseases 9th revision (ICD 9) and ICD 10 codes for peripheral nerve sheath tumor. Preoperative laboratories, comorbidities, and operative times were analyzed along with CSF leaks and unplanned returns to the operating room. Results Nine-hundred ninety-three patients fit the inclusion criteria. Average age was 51, 41% were male, and 58% were female. Mortality within 30 days of the operation was very low at 0.4%, complications were 7% with infection being the most common at 2.3%, and unplanned reoperations happened in 7.4% of the cases. Dependent functional status (odds ratio [OR]: 5.7, 95% confidence interval [CI]: 1.9–16.6, p = 0.001), preoperative anemia (OR: 2.4, 95% CI: 1.2–4.5, p = 0.009), and operative time over 8 hours (OR: 1.9, 95% CI: 1.1–3.4, p = 0.017) were the only significant predictors of perioperative complications. CSF leak postoperatively occurred in 37 patients (3.7%). Reoperation for CSF leak was necessary in 56.3% of the cases. Operative time over 8 hours was the only independent significant predictor of postoperative CSF leak (OR: 2.2, 95% CI: 1.1–4.3, p = 0.028). Conclusion Dependent functional status preoperatively, preoperative anemia, and duration of surgery over 8 hours are the greatest predictors of complications in the 30-day postoperative period.

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Section: Non-neurological Morbiditymentioning

confidence: 99%

Risk Factors for 30-Day Non-Neurological Morbidity and Cerebrospinal Fluid Leak in Patients Undergoing Surgery for Vestibular Schwannoma

Gelfand

Longo

Berezin

et al. 2019

J Neurol Surg B Skull Base

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“…As the prevalence of COPD continues to rise, elucidating COPD's effects on postoperative complications has become a more pressing matter [3,23]. COPD has been reported to increase rates of numerous complications after various surgical procedures including postoperative atrial fibrillation, pneumonia, and increased morbidity, mortality, length of stay, and unplanned readmission rates [10,13,17,25]. The effects of COPD on postoperative complications have also been well explored in various arthroplasty procedures.…”

Section: Introductionmentioning

confidence: 99%

Patients With Chronic Obstructive Pulmonary Disease Are at Higher Risk for Pneumonia, Septic Shock, and Blood Transfusions After Total Shoulder Arthroplasty

Lee

Mamidi

et al. 2018

Clin Orthop Relat Res

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Background Chronic obstructive pulmonary disease (COPD) has been associated with several complications after surgery, including pneumonia, myocardial infarction, septic shock, and mortality. To the authors' knowledge, there has been no work analyzing the impact of COPD on complications after total shoulder arthroplasty (TSA). Although previous work has elucidated the complications COPD has on TKA and THA, extrapolating the results of lower extremity arthroplasty to TSA may prove to be inaccurate. Compared with lower extremity arthroplasty, TSA is a relatively new procedure that has only recently gained popularity. Therefore, this study seeks to elucidate COPD's effects on complications in TSA specifically so that postoperative care can be tailored for these patient populations. Assessing these patients may enable surgeons to implement preoperative precautionary measures to prevent serious adverse events in these patients. Questions/purposes What serious postoperative complications are patients with COPD at risk for within the 30-day postoperative period after TSA? Methods The American College of Surgeons National Surgical Quality Improvement Program ® (ACS-NSQIP) database was queried to identify 14,494 patients who had undergone TSA between 2005 and 2016, excluding patients who had undergone hemiarthroplasties of the shoulder and revision shoulder arthroplasties. The ACS-NSQIP database was utilized in this study for the comprehensive preoperative and postoperative medical histories it provides for each patient for 274 characteristics. Among the 14,494 patients undergoing TSA, 931 (6%) patients who had a history of COPD were identified, and the two cohorts-COPD and non-COPD-were analyzed for differences in their demographic factors, comorbidities, and acute complications occurring within 30 days of their procedure. Univariate analyses were utilized to assess differences in the prevalence of demographic features, comorbidities, and perioperative/postoperative outcomes after surgery. Multivariate regression analyses were used to assess COPD as an independent risk factor associated with complications. Results COPD is an independent risk factor for three complications after TSA: pneumonia (odds ratio [OR], 2.793; 95% confidence interval [CI], 1.426-5.471; p = 0.003), bleeding resulting in transfusion (OR, 1.577; 95% CI, 1.155-2.154; p = 0.004), and septic shock (OR, 9.259; 95% CI, 2.140-40.057; p = 0.003).Each author certifies that neither he or she, nor any member of his or her immediate family, has funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

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“…Complications during index hospitalization were identified using ICD-9 codes and included intracranial hemorrhage, cardiorespiratory arrest, red blood cell (RBC) transfusion, cardiogenic shock, acute deep vein thrombosis (DVT), acute pulmonary embolus (PE), pneumonia, wound complication, sepsis and urinary tract infection and were selected due to their previously identified association with readmission after relevant operative procedures or traumatic injury. (16)(17)(18)(19)(20) The NRD includes a variable identifying presence of a major operating room procedure during the admission, which we used to differentiate "operative index admissions" (OI) from "non-operative index admissions" (NOI). To identify the primary operative procedure, we searched the listed ICD-9-CM procedure codes for the first operative procedure using the CCS procedure classification as detailed above.…”

Section: Variables Of Interestmentioning

confidence: 99%

“…Two-thirds of all readmissions took place in the first 14 days after discharge (median 9 days [ ). Readmissions after NOI occurred earlier than after OI (NOI median days post-discharge 8 [4][5][6][7][8][9][10][11][12][13][14][15][16] vs OI 11 [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19], p<0.001), with 47% of NOI readmissions occurring in the first week, compared to 36.1% of OI readmissions, p<0.001 (Table 2). NOI patients were readmitted to non-index hospitals more often than OI patients (30.7% vs 22.1%, p<0.001).…”

Section: Readmission Hospitalizationmentioning

confidence: 99%

“…OI patients had a higher rate of operative intervention during readmission (OI 47.7% vs NOI 31.2%, p<0.001); however, when limited to major trauma (ISS ≥15), there was no significant difference between the two groups (OI 38.4% vs NOI 36.5%, p=0.24). Patients requiring a major operative procedure when readmitted after NOI presented earlier (NOI median 9 [4][5][6][7][8][9][10][11][12][13][14][15][16], vs 13 [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20], p<0.001), with 44% of MOR NOI patients readmitted in the first week after discharge vs 29.7% of MOR OI, p<0.001 (Table 2).…”

Section: Operative Intervention During Readmissionmentioning

confidence: 99%

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Readmissions after nonoperative trauma: Increased mortality and costs with delayed intervention

McCrum

Zhang

Presson

et al. 2019

J Trauma Acute Care Surg

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Background:We sought to examine patterns of readmission after non-operative trauma, including rates of delayed operative intervention and mortality. Methods:The Nationwide Readmissions Database (2013Database ( -2014 was queried for all adult trauma admissions and 30-day readmissions. Index admissions were classified as operative (OI) or nonoperative (NOI), and readmissions examined for major operative intervention (MOR). Multivariable regression modeling was used to evaluate risk for readmission requiring MOR and in-hospital mortality.Results: Of 2,244,570 trauma admissions, there were 59,573 readmissions: 66% after NOI, and 35% after OI. Readmission rate was higher after NOI compared to OI (3.6% vs 1.7% p<0.001). Readmitted NOI patients were older, with a higher proportion of ISS ≥15 and were readmitted earlier (NOI median 8 days vs OI 11 days). 31% of readmitted NOI patients required MOR and experienced higher overall mortality compared to OI patients with operative readmission (NOI 2.9% vs OI 2%, p=0.02). Intracranial hemorrhage was an independent risk factor for NOI readmission requiring MOR in both the overall (HR 1.11 [95% CI 1.01-1.22]) and ISS ≥ 15 cohorts ), with a predominance of non-spine neurosurgical procedures (20.3% and 55.1%, respectively

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Clinical Risk Factors and Postoperative Complications Associated with Unplanned Hospital Readmissions After Cranial Neurosurgery

Cited by 20 publications

References 29 publications

Risk Factors for 30-Day Non-Neurological Morbidity and Cerebrospinal Fluid Leak in Patients Undergoing Surgery for Vestibular Schwannoma

Risk Factors for 30-Day Non-Neurological Morbidity and Cerebrospinal Fluid Leak in Patients Undergoing Surgery for Vestibular Schwannoma

Patients With Chronic Obstructive Pulmonary Disease Are at Higher Risk for Pneumonia, Septic Shock, and Blood Transfusions After Total Shoulder Arthroplasty

Readmissions after nonoperative trauma: Increased mortality and costs with delayed intervention

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