Causes of 30-day readmission after neurosurgery of the spine

Michael D Cusimano; Iryna Pshonyak; Michael Y Lee; Gabriela Ilie

doi:10.3171/2015.4.SPINE15445

Causes of 30-day readmission after neurosurgery of the spine

J Neurosurg Spine. 2016 Feb;24(2):281-290. doi: 10.3171/2015.4.SPINE15445. Epub 2015 Oct 9.

Authors

Michael D Cusimano^{1

2}, Iryna Pshonyak¹, Michael Y Lee¹, Gabriela Ilie¹

Affiliations

¹ Division of Neurosurgery, Keenan Research Centre and Li Ka Shing Knowledge Institute, St. Michael's Hospital; and.
² Dalla Lana School of Public Health and Department of Surgery, University of Toronto, Ontario, Canada.

PMID: 26451667
DOI: 10.3171/2015.4.SPINE15445

Abstract

OBJECT Thirty-day readmission has been cited as an important indicator of the quality of care in several fields of medicine. The aim of this systematic review was to examine rate of readmission and factors relevant to readmission after neurosurgery of the spine. METHODS The authors carried out a systematic review using several databases, searches of cited reference lists, and a manual search of the JNS Publishing Group journals (Journal of Neurosurgery; Journal of Neurosurgery: Spine; Journal of Neurosurgery: Pediatrics; and Neurosurgical Focus), Neurosurgery, Acta Neurochirurgica, and Canadian Journal of Neurological Sciences. A quality review was performed using STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) criteria and reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RESULTS A systematic review of 1136 records published between 1947 and 2014 revealed 31 potentially eligible studies, and 5 studies met inclusion criteria for content and quality. Readmission rates varied from 2.54% to 14.7%. Sequelae that could be traced back to complications that arose during neurosurgery of the spine were a prime reason for readmission after discharge. Increasing age, poor physical status, and comorbid illnesses were also important risk factors for 30-day readmission. CONCLUSIONS Readmission rates have predictable factors that can be addressed. Strategies to reduce readmission that relate to patient-centered factors, complication avoidance during neurosurgery, standardization with system-wide protocols, and moving toward a culture of nonpunitive system-wide error and "near miss" investigations and quality improvement are discussed.

Keywords: ASA = American Society of Anesthesiologists; CPT = Current Procedural Terminology; DVT = deep vein thrombosis; LOS = length of stay; PCI = percutaneous coronary intervention; PE = pulmonary embolism; PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses; SSI = surgical site infection; UTI = urinary tract infection; neurosurgery; outcomes; readmission; spine; systematic review.