Introduction: Quality measures play an increasingly important role in the delivery and reimbursement of medical care. One such measurement is unexpected return to the health care system within thirty days of surgery.
Methods: Demographic, socioeconomic, and clinical characteristics were prospectively collected for all patients undergoing neurosurgical procedures over one year. The primary end point was an unexpected return to the hospital system within 30 days after index surgery.
Results: There were 1358 pediatric neurosurgery procedures in 2012. Emergency department admission preceded 37.4% of surgeries. Medicare/Medicaid was the payee for 54.9 % of surgeries. 37.6% of surgeries were shunt-related. There were 169 unexpected returns to the system within 30 days, and 116 were related to the index surgery (related returns). Common concerns were headache, nausea, vomiting or seizure after shunt or cranial surgery (n=65) and wound concerns (n=30). 37 of the 116 (32%) returns required surgery. The monthly rate of unplanned returns was 8.6 +/- 2.5%. Analyzing related returns only (n=116), patients who underwent shunt-related surgery were more likely to return to the system unexpectedly (O.R. 1.86, p=0.008) and require surgery on readmission (O.R. 3.28, p=0.004). Because extended hospitalization shortened the window of time for readmission after surgery, extended length of stay protected against return to system. Importantly, if related and unrelated returns were analyzed together (n=169), no independent risk factor for return to system could be identified.
Conclusions: Quality assessment measures must be carefully defined, and surgeons must play a role in development of measures to ensure meaningful results. Certain patients, such as those who undergo VP shunt placement, are more likely to return to the health care system after surgery, and this may relate to factors other than quality of health care.
Patient Care: Neurosurgeons need to understand and be involved with the development of metrics that are used to measure health care quality. This work will help neurosurgeons better understand the benefits and limitations of quality measures and identify patients at risk for readmission after surgery.
Learning Objectives: Quality metrics must be carefully defined, as the definition will impact analytical results. Surgeons must play a leading role in the development of quality measures to ensure meaningful results.