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  • Clinical Risk Factors and Post-Operative Complications Associated with Unplanned Hospital Readmissions After Cranial Neurosurgery

    Final Number:

    Christian Lopez Ramos MPH; Jeffrey Steinberg MD; Michael G Brandel BA; Robert Rennert MD; David Rafael Santiago-Dieppa MD; Arvin Raj Wali BA; Jeffrey Scott Pannell MD; Alexander Arash Khalessi MD, MS

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Hospital readmission is a key surgical quality metric associated with financial penalties and higher healthcare costs. We examined clinical risk factors and post-operative complications associated with 30-day unplanned hospital readmissions after cranial neurosurgery.

    Methods: We queried the American College of Surgeons National Surgical Quality Improvement Program database from 2011-2016 for adult patients that underwent a cranial neurosurgical procedure. Patient demographics, comorbidities, clinical characteristics, and post-operative complications were extracted. Patients who died during initial hospitalization were excluded. Multivariable logistic regression with backwards model selection was used to determine predictors associated with 30-day unplanned hospital readmission.

    Results: Of 40,802 neurosurgical cranial cases, 4,147 (10.2%) had an unplanned readmission. The rate of any post-operative complication was higher in the unplanned readmission cohort (18.5% vs 9.9%, p <0.001). On adjusted analysis, clinical factors associated with increased odds of 30-day unplanned readmission were hypertension, COPD, diabetes, bleeding disorders, chronic steroid use, and dependent functional status (p <0.01). Pre-operative laboratory values predictive of unplanned readmission included hematocrit <36, sodium <135, and albumin <3.5 (all p <0.01). Higher ASA class (III-V), operative time >216 minutes, and unplanned reoperation were also significantly associated with increased likelihood of readmission (all p <0.001). Post-operative complications predictive of unplanned readmissions were wound infection (OR 4.90, p <0.001), pulmonary embolus (p=3.94, <0.001), myocardial infarction/cardiac arrest (OR 2.25, p <0.001), sepsis (OR 1.72, p <0.001), deep venous thrombosis (1.50, p=0.007), and urinary tract infection (OR 1.46, p=0.001). Female sex, transfer status, and post-operative pulmonary complications were associated with decreased odds of readmission (all p <0.05)

    Conclusions: Unplanned hospital readmission after cranial neurosurgery is a common event. Identification of high-risk patients who undergo cranial procedures may allow hospitals to reduce unplanned readmissions and associated healthcare costs.

    Patient Care: Unplanned hospital readmission after cranial neurosurgery is a common occurrence. Identifying patients that are at risk of unplanned readmission may improve patient outcomes and reduce the burden of healthcare costs associated with readmission.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Discuss preoperative comorbidities and preoperative laboratory values associated with increased risk of unplanned readmission 2) Discuss post-operative complications associated with unplanned readmission


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