• Christian Lopez Ramos, Michael G Brandel, Robert C Rennert, Arvin R Wali, Jeffrey A Steinberg, David R Santiago-Dieppa, Brittany N Burton, Jeffrey S Pannell, Scott E Olson, and Alexander A Khalessi.
• Department of Neurological Surgery, University of California, San Diego, La Jolla, California, USA. Electronic address: clopez@ucsd.edu.
• World Neurosurg. 2018 Nov 1; 119: e294-e300.

BackgroundHospital readmission is a key surgical quality metric associated with financial penalties and greater healthcare costs. We examined the clinical risk factors and postoperative complications associated with 30-day unplanned hospital readmissions after cranial neurosurgery.MethodsWe queried the American College of Surgeons National Surgical Quality Improvement Program database from 2011 to 2016 for adult patients who had undergone a cranial neurosurgical procedure. Multivariable logistic regression with backward model selection was used to determine the predictors associated with 30-day unplanned hospital readmission.ResultsOf 40,802 cranial neurosurgical cases, 4147 (10.2%) required an unplanned readmission. Postoperative complications were greater in the readmission cohort (18.5% vs. 9.9%; P < 0.001). On adjusted analysis, the clinical factors predictive of unplanned readmission included hypertension, chronic obstructive pulmonary disease, diabetes, coagulopathy, chronic steroid use, and preoperative anemia, hyponatremia, and hypoalbuminemia (P ≤ 0.01 for all). Higher American Society of Anesthesiology class (III to V), operative time >216 minutes, and unplanned reoperation were also associated with an increased likelihood of readmission (P ≤ 0.001 for all). The postoperative complications predictive of unplanned readmissions were wound infection (odds ratio [OR], 4.90; P < 0.001), pulmonary embolus (OR, 3.94; P < 0.001), myocardial infarction or cardiac arrest (OR, 2.37; P < 0.001), sepsis (OR, 1.73; P < 0.001), deep venous thrombosis (OR, 1.50; P = 0.002), and urinary tract infection (OR, 1.45; P = 0.002). Female sex, transfer status, and postoperative pulmonary complications were protective of readmission (P < 0.05 for all).ConclusionsUnplanned hospital readmission after cranial neurosurgery is a common event. The identification of high-risk patients who undergo cranial procedures might allow hospitals to reduce unplanned readmissions and their associated healthcare costs.Copyright © 2018 Elsevier Inc. All rights reserved.

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