• Robin Babadjouni, Timothy Wen, Daniel A Donoho, Ian A Buchanan, Steven Y Cen, Rick A Friedman, Arun Amar, Jonathan J Russin, Steven L Giannotta, William J Mack, and Frank J Attenello.
• Department of Neurological Surgery, University of Southern California, Los Angeles, California.
• Neurosurgery. 2019 Mar 1; 84 (3): 726-732.

BackgroundHospital readmissions are commonly linked to elevated health care costs, with significant financial incentive introduced by the Affordable Care Act to reduce readmissions.ObjectiveTo study the association between patient, hospital, and payer factors with national rate of readmission in acoustic neuroma surgery.MethodsAll adult inpatients undergoing surgery for acoustic neuroma in the newly introduced Nationwide Readmissions Database from 2013 to 2014 were included. We identified readmissions for any cause with a primary diagnosis of neurological, surgical, or systemic complication within 30- and 90-d after undergoing acoustic neuroma surgery. Multivariable models were employed to identify patient, hospital, and administrative factors associated with readmission. Hospital volume was measured as the number of cases per year.ResultsWe included patients representing a weighted estimate of 4890 admissions for acoustic neuroma surgery in 2013 and 2014, with 355 30-d (7.7%) and 341 90-d (9.1%) readmissions. After controlling for patient, hospital, and payer factors, procedural volume was significantly associated with 30-d readmission rate (OR [odds ratio] 0.992, p = 0.03), and 90-d readmission rate (OR 0.994, p = 0.047). The most common diagnoses during readmission in both 30- and 90-d cohorts included general central nervous system complications/deficits, hydrocephalus, infection, and leakage of cerebrospinal fluid (rhinorrhea/otorrhea).ConclusionAfter controlling for patient, hospital, and payer factors, increased procedural volume is associated with decreased 30- and 90-d readmission rate for acoustic neuroma surgery. Future studies seeking to improve outcomes and reduce cost in acoustic neuroma surgery may seek to further evaluate the role of hospital procedural volume and experience.Copyright © 2018 by the Congress of Neurological Surgeons.

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