Introduction: Despite the low risk of spontaneous rupture with un-ruptured intracranial aneurysms (UIAs), the devastating outcome of hemorrhage often prompts elective treatments such as surgical clipping. Unplanned post-operative readmissions are a poorly characterized metric in this population. Excessive readmissions compromise patient outcomes and satisfaction and present additional cost to hospital systems. This study identifies risk factors for readmission following surgical clipping of un-ruptured intracranial aneurysms.
Methods: The National Readmission Database (NRD) was queried to identify all patients who underwent clipping of a UIA for the 2013 calendar year. Patients were grouped by readmission status: No Readmission and Unplanned 30-Day Readmission. Patient characteristics, comorbidities, hospital characteristics, and discharge dispositions were collected for each patient. The primary outcome investigated was unplanned 30-day readmission rate and associated factors.
Results: There were 410 patients who underwent surgical clipping for a UIA, of whom 9.5% (n = 39) had an unplanned readmission within 30 days of discharge and 90.5% (n = 371) had no readmission, planned readmission, or readmission more than 30 days after discharge. Baseline patient demographics including age and gender were similar, but readmitted patients had a significantly lower prevalence of private insurance (33.3% vs. 51.2%, p=0.02). These patients also had a higher prevalence of congestive heart failure (7.7% vs 1.3%, p=0.03), pulmonary circulation disorders (5.1% vs. 0.3%, p=0.02), and renal failure (10.3% vs 1.6%, p=0.01). There were no significant differences in other comorbidities or in occurrence of the most common post-operative complications, such as cerebral edema (3.5% vs 5.1%, p=0.64) or cerebral artery occlusion (3.2% vs 0%, p=0.61).
Conclusions: Factors associated with an increased rate of unplanned 30-day readmissions in this population include: private insurance status, congestive heart failure, pulmonary circulation disorders, and renal failure. Further studies are necessary to identify and reduce causes of preventable unplanned readmissions in this patient population.
Patient Care: 1) Better characterization and recognition of patients likely to require readmission following surgical clipping of intracranial aneurysms.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Recognize risk factors for readmission in patients undergoing surgical clipping for intracranial aneurysms.