Early unplanned readmission of neurosurgical patients after treatment of intracranial lesions: a comparison between surgical and non-surgical intervention group

Abstract

Background Recent health care policy making has highlighted the necessity for understanding factors that influence readmission. To elucidate the rate, reason, and predictors of readmissions in neurosurgical patients, we analyzed unscheduled readmissions to our neurosurgical department after treatment for cranial or cerebral lesions. Methods From 2015 to 2017, all adult patients who had been discharged from our Department of Neurosurgery and were readmitted within 30 days were included into the study cohort. The patients were divided into a surgical and a non-surgical group. The main outcome measure was unplanned inpatient admission within 30 days of discharge. Results During the observation period, 183 (7.4%) of 2486 patients had to be readmitted unexpectedly within 30 days after discharge. The main readmission causes were surgical site infection (34.4 %) and seizure (16.4%) in the surgical group, compared to natural progression of the original diagnosis (38.2%) in the non-surgical group. Most important predictors for an unplanned readmission were younger age, presence of malignoma (OR: 2.44), and presence of cardiovascular side diagnoses in the surgical group. In the non-surgical group, predictors were length of stay (OR: 1.07) and the need for intensive care (OR: 5.79). Conclusions We demonstrated that reasons for readmission vary between operated and non-operated patients and are preventable in large numbers. In addition, we identified treatment-related partly modifiable factors as predictors of unplanned readmission in the non-surgical group, while unmodifiable patient-related factors predominated in the surgical group. Further patient-related risk adjustment models are needed to establish an individualized preventive strategy in order to reduce unplanned readmissions.

The Relation of Surgical Procedures And Diagnosis Groups To Unplanned Readmission In Spinal Neurosurgery. A Retrospective Single Center Study.

“…Gender was con rmed to be a risk factor for unplanned readmission in some studies [28]. In addition, we identi ed PCCL as a predictor, in accordance with previous studies [5,6]. PCCL represents a good measurement for the severity of the patient's secondary diseases [29] and also provides indirect information on the presence of complications during an inpatient stay, which can be taken into account preoperatively.…”

“…The readmission rate for spine patients after neurosurgical treatment in the present study lies with 4.27 % much lower than the 7.4 % rate in our corresponding local patient cohort receiving cranial neurosurgical treatment [6]. This difference can partly be explained by the higher complexity of cranial surgery and the longer cranial neurosurgical intervention times as well as the higher need for inpatient treatment when complications arise [4].…”

“…Rather similar to cranial neurosurgical patients, patient-dependent factors, such as the presence of diabetes mellitus as a pre-existing condition, were associated with an increased risk of readmission [6]. Diabetes mellitus increases the risk of SSI after lumbar spine surgery [26] and results in prolonged LOS [27].…”

“…The predictors and causes for unplanned readmission are manifold, re ecting the heterogeneous patient population in neurosurgery [4,5]. Readmission rates in cranial neurosurgery have been found to be surgery-and diagnosis-dependent [6]. In the current literature, the majority of studies and predictor analyses were done in North America on patients with spinal disorders in neurosurgery [7].…”

Neurosurgical Care during the COVID-19 Pandemic in Central Germany: A Retrospective Single Center Study of the Second Wave

“…Consequently, universal recommendations have been necessary. Numerous guidelines and recommendations for prioritizing, shifting, and structurally utilizing tightening resources during the pandemic were published [7][8][9].…”