Introduction: Reducing the rate of hospital readmission within 30 days of discharge has become a priority in current U.S. healthcare reform. A reduction in readmissions would lower the associated morbidity of hospitalization as well as the related economic burden. Although an increasing number of studies have better characterized readmission in neurosurgery, little is known about readmission after neuroendovascular procedures. We sought to determine the reasons for readmission after neuroendovascular procedures, as well as the times at which they occur.
Methods: We conducted a longitudinal study of neuroendovascular procedures from 2009-2012 using the New York Statewide Planning And Research Cooperative System (SPARCS), which collects patient-level details for every hospital admission and discharge within the State of New York. A hierarchical analysis of ICD-9 diagnostic and procedural codes was used to define neuroendovascular procedures and determine the causes of readmission. Diagnostic angiography cases and planned readmissions were excluded.
Results: Of the 4,828 patients admitted for a neuroendovascular procedure, 447 (9.26%) were readmitted, at a median of 9 days (IQR: 4-18). The most common causes of unplanned readmission were infections (19.2%), strokes (19.0%), and non-infectious medical complications (18.6%) (Figure 1). Early causes of readmission included sepsis (median 4.5 days), and subarachnoid hemorrhage (6 days), followed by pneumonia (8 days). Later causes included ischemic stroke (9 days), hardware malfunction (10 days), cardiac complications (11 days), renal complications (12 days), and urinary tract infections (14 days) (Figure 2).
Conclusions: Strokes, infections, and medical complications are responsible for the majority of unplanned readmissions following neuroendovascular surgery. Each account for a similar proportion of unplanned readmissions. While early causes of readmission are not necessarily attributable to the procedure performed, later causes may be associated with hospitalization-related complications. Improved outpatient management that focuses on detecting acute neurological symptoms early after discharge, and more general complications (eg. UTI, cardiac) later may assist in reducing readmission rates.
Patient Care: A better understanding of the causes of 30-day readmission, as well as when they are likely to occur, will allow development of models that predict the risk of readmission. Interventions may then be devised (eg. screening for infection at follow-up) to reduce the rate of readmission, which would improve quality of care, reduce patient morbidity, and cut costs.
Learning Objectives: By the conclusion of this session participants should be aware that:
1) Infection, medical complications, and stroke are the primary causes of readmission after neuroendovascular procedures
2) Sepsis and subarachnoid hemorrhage are early causes of readmission
References: Ashton CM, Kuykendall DH, Johnson ML, Wray NP, Wu L. The association between the quality of inpatient care and early readmission. Annals of internal medicine. 1995;122:415-421.
Axon RN, Williams MV. Hospital readmission as an accountability measure. JAMA : the journal of the American Medical Association. 2011;305:504-505.
Shah MN, Stoev IT, Sanford DE, et al. Are readmission rates on a neurosurgical service indicators of quality of care? Journal of neurosurgery. 2013;119:1043-1049.
Buchanan CC, Hernandez EA, Anderson JM, et al. Analysis of 30-day readmissions among neurosurgical patients: surgical complication avoidance as key to quality improvement. Journal of neurosurgery. 2014;121:170-175.