gms | German Medical Science

Objective: Rising costs of health and care delivery have become a central issue across all medical specialties. As a consequence, health care administrators and medical policy makers have shifted the focus towards the quality of delivered care and are implementing quality measures that are readily available. However, these may be inadequate and inaccurate for the specialty of neurosurgery. One suggested quality indicator is the 30-day- readmission rate. We aimed to analyse this factor in our department and to discuss the implications of this potential indicator for neurosurgical practice.

Methods: We performed a retrospective analysis on all adult patients that had undergone an inpatient neurosurgical procedure at our university’s neurosurgical department between January 2010 and March 2016 and had been readmitted to our department within 30 days. Reasons for readmission were analysed regarding different neurosurgical diagnoses and were broadly categorised into surgical complications (surgical site infection, CSF leakage, postoperative haemorrhage), medical diagnosis/complication, pain management, progression of original diagnosis and implant dysfunction.

Results: Over the study period, 323 (3.6%) of 8878 patients were readmitted within 30 days. The over-all unplanned re-admission rate was 2.9% (260 cases). The most common reasons for readmissions were postoperative haemorrhage in trauma patients (n=4, 28.6%), wound infections in benign and malignant brain tumours and in spinal cases (n= 16, 33.3%, n=18, 28.7%, n=14, 23.7% respectively); shunt dysfunction was the major reason for readmission in hydrocephalus patients (n=28, 63.6%). Only 1.9% (n=5) of the readmitted patients were readmitted for medical problems unrelated to the neurosurgical disease.

Conclusion: The over-all unplanned readmission rate of 2,9% was low. Surgical complications seem to be a major reason for readmission. For quality issues, only the unplanned readmission rate should be considered as many readmissions are prescheduled owing to the complexity of the underlying neurosurgical disorder. Readmission rates are easy to track, possibly preventable and therefore a feasible quality indicator. However, applying readmission rates as quality indicator requires adequate strategies for risk adjustment, that can be achieved by collecting clinical data in prospective neurosurgical registries.