• Blake E S Taylor, Brett E Youngerman, Hannah Goldstein, Daniel H Kabat, Geoffrey Appelboom, William E Gold, and Edward Sander Connolly.
• *Department of Neurosurgery, ‡College of Physicians and Surgeons, §Cerebrovascular Laboratory, ‖Department of Epidemiology, #Department of Health Policy and Management, Mailman School of Public Health, **Neuro-Intensive Care Unit, Columbia University Medical Center, Columbia University, New York, New York; ¶Gold Health Strategies, Inc., New York, New York.
• Neurosurgery. 2016 Sep 1; 79 (3): 356-69.

BackgroundReducing the rate of 30-day hospital readmission has become a priority in healthcare quality improvement policy, with a focus on better characterizing the reasons for unplanned readmission. In neurosurgery, however, peer-reviewed analyses describing the patterns of readmission have been limited in their number and generalizability.ObjectiveTo determine the incidence, timing, and causes of 30-day readmission after neurosurgical procedures.MethodsWe conducted a retrospective longitudinal study from 2009 to 2012 using the Statewide Planning And Research Cooperative System, which collects patient-level details for all admissions and discharges within New York. We identified patients readmitted within 30 days of initial discharge. The rate of, reasons for, and time to readmission were determined overall and within 4 subgroups: craniotomies, cranial surgery without craniotomy, spine, and neuroendovascular procedures.ResultsThere were 163 743 index admissions, of whom 14 791 (9.03%) were readmitted. The most common reasons for unplanned readmission were infection (29.52%) and medical complications (19.22%). Median time to readmission was 11 days, with hemorrhagic strokes and seizures occurring earlier, and medical complications and infections occurring later. Readmission rates were highest among patients undergoing cerebrospinal fluid shunt revision and malignant tumor resection (15.57%-22.60%). Spinal decompressions, however, accounted for the largest volume of readmissions (33.13%).ConclusionMany readmissions may be preventable and occur at predictable time intervals. The causes and timing of readmission vary significantly across neurosurgical subgroups. Future studies should focus on detecting specific complications in select cohorts at predefined time points, which may allow for interventions to lower costs and reduce patient morbidity.AbbreviationsCSF, cerebrospinal fluidIQR, interquartile rangeSPARCS, Statewide Planning And Research Cooperative System.

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