Unplanned readmissions and survival following brain tumor surgery

Holly Dickinson, Christine Carico, Miriam A Nuno, Debraj Mukherjee, Alicia Ortega, Keith L. Black, Chirag G. Patil

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Object Research on readmissions has been influenced by efforts to reduce hospital cost and avoid penalties stipulated by the Centers for Medicare and Medicaid Services. Less emphasis has been placed on understanding these readmissions and their impact on patient outcomes. This study 1) delineates reasons for readmission, 2) explores factors associated with readmissions, and 3) describes their impact on the survival of glioblastoma patients. Methods The authors conducted a retrospective review of 362 cases involving patients with glioblastoma undergoing biopsy or tumor resection at their institution between 2003 and 2011. Reasons for re-hospitalization were characterized according to whether or not they were related to surgery and considered preventable. Multivariate analyses were conducted to identify the effect of readmission on survival and determine factors associated with re-hospitalizations. Results Twenty-seven (7.5%) of 362 patients experienced unplanned readmissions within 30 days of surgery. Six patients (22.2%) were readmitted by Day 7, 14 (51.9%) by Day 14, and 20 (74.1%) by Day 21. Neurological, infectious, and thromboembolic complications were leading reasons for readmission, accounting for, respectively, 37.0%, 29.6%, and 22.2% of unplanned readmissions. Twenty-one (77.8%) of the 27 readmissions were related to surgery and 19 (70.4%) were preventable. The adjusted hazard ratio of mortality associated with a readmission was 2.03 (95% CI 1.3-3.1). Higher-functioning patients (OR 0.96, 95% CI 0.9-1.0) and patients discharged home (OR 0.21, 95% CI 0.1-0.6) were less likely to get readmitted. Conclusions An overwhelming fraction of documented unplanned readmissions were considered preventable and related to surgery. Patients who were readmitted to the hospital within 30 days of surgery had twice the risk of mortality compared with patients who were not readmitted.

Original languageEnglish (US)
Pages (from-to)61-68
Number of pages8
JournalJournal of Neurosurgery
Volume122
Issue number1
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

Fingerprint

Brain Neoplasms
Survival
Glioblastoma
Ambulatory Surgical Procedures
Hospitalization
Centers for Medicare and Medicaid Services (U.S.)
Mortality
Hospital Costs
Multivariate Analysis
Biopsy
Research

Keywords

  • Complications
  • Functional status
  • Glioblastoma
  • Oncology
  • Unplanned readmission

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)
  • Clinical Neurology

Cite this

Dickinson, H., Carico, C., Nuno, M. A., Mukherjee, D., Ortega, A., Black, K. L., & Patil, C. G. (2015). Unplanned readmissions and survival following brain tumor surgery. Journal of Neurosurgery, 122(1), 61-68. https://doi.org/10.3171/2014.8.JNS1498

Unplanned readmissions and survival following brain tumor surgery. / Dickinson, Holly; Carico, Christine; Nuno, Miriam A; Mukherjee, Debraj; Ortega, Alicia; Black, Keith L.; Patil, Chirag G.

In: Journal of Neurosurgery, Vol. 122, No. 1, 01.01.2015, p. 61-68.

Research output: Contribution to journalArticle

Dickinson, H, Carico, C, Nuno, MA, Mukherjee, D, Ortega, A, Black, KL & Patil, CG 2015, 'Unplanned readmissions and survival following brain tumor surgery', Journal of Neurosurgery, vol. 122, no. 1, pp. 61-68. https://doi.org/10.3171/2014.8.JNS1498
Dickinson H, Carico C, Nuno MA, Mukherjee D, Ortega A, Black KL et al. Unplanned readmissions and survival following brain tumor surgery. Journal of Neurosurgery. 2015 Jan 1;122(1):61-68. https://doi.org/10.3171/2014.8.JNS1498
Dickinson, Holly ; Carico, Christine ; Nuno, Miriam A ; Mukherjee, Debraj ; Ortega, Alicia ; Black, Keith L. ; Patil, Chirag G. / Unplanned readmissions and survival following brain tumor surgery. In: Journal of Neurosurgery. 2015 ; Vol. 122, No. 1. pp. 61-68.
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abstract = "Object Research on readmissions has been influenced by efforts to reduce hospital cost and avoid penalties stipulated by the Centers for Medicare and Medicaid Services. Less emphasis has been placed on understanding these readmissions and their impact on patient outcomes. This study 1) delineates reasons for readmission, 2) explores factors associated with readmissions, and 3) describes their impact on the survival of glioblastoma patients. Methods The authors conducted a retrospective review of 362 cases involving patients with glioblastoma undergoing biopsy or tumor resection at their institution between 2003 and 2011. Reasons for re-hospitalization were characterized according to whether or not they were related to surgery and considered preventable. Multivariate analyses were conducted to identify the effect of readmission on survival and determine factors associated with re-hospitalizations. Results Twenty-seven (7.5{\%}) of 362 patients experienced unplanned readmissions within 30 days of surgery. Six patients (22.2{\%}) were readmitted by Day 7, 14 (51.9{\%}) by Day 14, and 20 (74.1{\%}) by Day 21. Neurological, infectious, and thromboembolic complications were leading reasons for readmission, accounting for, respectively, 37.0{\%}, 29.6{\%}, and 22.2{\%} of unplanned readmissions. Twenty-one (77.8{\%}) of the 27 readmissions were related to surgery and 19 (70.4{\%}) were preventable. The adjusted hazard ratio of mortality associated with a readmission was 2.03 (95{\%} CI 1.3-3.1). Higher-functioning patients (OR 0.96, 95{\%} CI 0.9-1.0) and patients discharged home (OR 0.21, 95{\%} CI 0.1-0.6) were less likely to get readmitted. Conclusions An overwhelming fraction of documented unplanned readmissions were considered preventable and related to surgery. Patients who were readmitted to the hospital within 30 days of surgery had twice the risk of mortality compared with patients who were not readmitted.",
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AB - Object Research on readmissions has been influenced by efforts to reduce hospital cost and avoid penalties stipulated by the Centers for Medicare and Medicaid Services. Less emphasis has been placed on understanding these readmissions and their impact on patient outcomes. This study 1) delineates reasons for readmission, 2) explores factors associated with readmissions, and 3) describes their impact on the survival of glioblastoma patients. Methods The authors conducted a retrospective review of 362 cases involving patients with glioblastoma undergoing biopsy or tumor resection at their institution between 2003 and 2011. Reasons for re-hospitalization were characterized according to whether or not they were related to surgery and considered preventable. Multivariate analyses were conducted to identify the effect of readmission on survival and determine factors associated with re-hospitalizations. Results Twenty-seven (7.5%) of 362 patients experienced unplanned readmissions within 30 days of surgery. Six patients (22.2%) were readmitted by Day 7, 14 (51.9%) by Day 14, and 20 (74.1%) by Day 21. Neurological, infectious, and thromboembolic complications were leading reasons for readmission, accounting for, respectively, 37.0%, 29.6%, and 22.2% of unplanned readmissions. Twenty-one (77.8%) of the 27 readmissions were related to surgery and 19 (70.4%) were preventable. The adjusted hazard ratio of mortality associated with a readmission was 2.03 (95% CI 1.3-3.1). Higher-functioning patients (OR 0.96, 95% CI 0.9-1.0) and patients discharged home (OR 0.21, 95% CI 0.1-0.6) were less likely to get readmitted. Conclusions An overwhelming fraction of documented unplanned readmissions were considered preventable and related to surgery. Patients who were readmitted to the hospital within 30 days of surgery had twice the risk of mortality compared with patients who were not readmitted.

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