Free Article: Causes and Timing of Unplanned Early Readmission After Neurosurgery

 

Reducing the rate of early hospital readmission, particularly those occurring within 30 days of discharge, is a priority in current US healthcare reform. Thirty-day readmission is associated with increased patient morbidity, as well as a significant economic burden.1-3 Although certain readmissions may not be avoidable, or may even be planned, repeated epidemiological studies have shown that a significant proportion of unplanned readmissions are preventable. As a result, 30-day readmission rates are increasingly being used as a surrogate metric for both the quality and value of care, and hospitals with higher readmission rates are subject to reimbursement penalties from the Centers for Medicare and Medicaid Services.

Among Medicare patients, the overall rate of readmission within 30 days of hospital discharge is nearly 20%, and there is an associated annual cost of more than $24 billion when one includes those treated in Veterans Administration hospitals as well.10-14 While the average cost of all readmissions is approximately $2200 per case, the cost of readmission after surgery is 4 to 13 times higher than this average, and the average neurosurgical readmission cost is at the high end of this range (nearly $30 000 per readmission). Not only are neurosurgical readmissions more expensive, but unlike those related to orthopedic, otolaryngological, plastic, thoracic, peripheral vascular, and cardiac surgery, the rates of readmission do not also seem to be decreasing. Furthermore, neurosurgical readmissions, unlike several other categories of readmissions, have been shown to be associated not only with increased morbidity, but also with increased mortality. In order to lower the rate of readmission in neurosurgery, it is first necessary to better define the patient populations who are readmitted and determine the underlying causes of readmission. This will allow for the development of models to predict and eventually reduce readmission rates, which will ultimately lower costs, decrease Centers for Medicare and Medicaid Services penalties, and improve patient morbidity and quality of life.

From Causes and Timing of Unplanned Early Readmission After Neurosurgery by Taylor et al.