Analysis of 30-day readmissions among neurosurgical patients: Surgical complication avoidance as key to quality improvement - Clinical article

Colin C. Buchanan, Estebes A. Hernandez, Jody M. Anderson, Justin A. Dye, Michelle Leung, Farzad Buxey, Marvin Bergsneider, Nasim Afsar-Manesh, Nader Pouratian, Neil A. Martin

Research output: Contribution to journalArticlepeer-review

Abstract

Object. In terms of measuring quality of care and hospital performance, an outcome of increasing interest is the 30-day readmission rate. Recent health care policy making has highlighted the necessity of understanding the factors that influence readmission. To elucidate the rate, reason, and predictors of readmissions at a tertiary/quaternary neurosurgical service, the authors studied 30-day readmissions for the Department of Neurosurgery at two University of California, Los Angeles (UCLA), hospitals. Methods. Over a 3-year period, the authors retrospectively identified adult and pediatric patients who had been discharged from the UCLA Medical Center after having undergone a major neurosurgical procedure and being readmitted within 30 days. Data were obtained on demographics, follow-up findings, diagnosis and reason for readmission, major operations performed, and length of stay during index admission and readmission. Reasons for readmission were broadly categorized into surgical, medical diagnosis/complication, problem associated with the original diagnosis, neurological decompensation, pain management, and miscellaneous. For further characterization, subgroup analysis and in-depth chart review were performed. Results. Over the study period, 365 (6.9%) of 5569 patients were readmitted within 30 days. The most common diagnosis at index admission was brain tumor (102 patients), followed by CSF shunt malfunction (63 patients). The most common reason for readmission was surgical complication (50.1%). Among those with surgical complications, the largest subgroup consisted of patients with CSF shunt-related problems (77 patients). The second and third largest subgroups were surgical site infection and CSF leakage (41 and 31 patients, respectively). Medical diagnosis/complication was the second most frequent (27.9%) reason for readmission. Conclusions. Surgical complications seem to be a major reason for readmission at the neurosurgical practice studied. Results indicate that the outcomes that are amenable to and would have the greatest effect on quality improvement are CSF shunt-related complications, surgical site infections, and CSF leaks.

Original languageEnglish (US)
Pages (from-to)170-175
Number of pages6
JournalJournal of neurosurgery
Volume121
Issue number1
DOIs
StatePublished - Jul 2014
Externally publishedYes

Keywords

  • 30-Day readmission
  • Neurosurgery
  • Preventability
  • Quality improvement

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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