title: Return to system within 30 days of discharge following pediatric non-shunt surgery.
abstract: OBJECTIVE
  Hospital readmission after discharge is a commonly used quality measure. In a previous study, the authors had documented the rate of readmission and reoperation after pediatric CSF shunt surgery. This study documents the rate of readmission and reoperation after pediatric neurosurgical procedures excluding those related to CSF shunts.
  
  
  METHODS
  Between May 1, 2009, and April 30, 2013, 3098 non-shunt surgeries during 2924 index admissions were performed at a single institution. Demographic, socioeconomic, and clinical characteristics were prospectively collected in the administrative, business, and clinical databases. Clinical events within the 30 days following discharge were reviewed and analyzed. The following events of interest were analyzed for risk factor associations using multivariate logistic regression: return to the emergency department (ED), all-cause readmission, readmission to the neurosurgical service, and reoperation.
  
  
  RESULTS
  The number of all-cause readmissions within 30 days of discharge was 304 (10.4%, 304/2924). Admission sources consisted of the ED (n = 173), hospital transfers (n = 47), and others (n = 84). One hundred eighty of the 304 readmissions were associated with an operation, but only 153 were performed by the neurosurgical service (reoperation rate = 5.2%). These procedures included wound revisions (n = 30) and first-time shunt insertions (n = 35). The remaining 124 readmissions were nonsurgical, and only 54 were admitted to the neurosurgical service for issues related to the index non-shunt surgery. Thus, the rate of related readmission was 7.1% ([153 + 54]/2924). A longer length of stay and admission to the neonatal intensive care unit during the index admission were associated with an increased likelihood of return to the ED and readmission. Certain procedures, such as baclofen pump insertion and intracranial pressure monitor placement, were also found to be associated with adverse clinical events in the 30-day period. Lastly, patients were more likely to a undergo reoperation if the index procedure had started after 3 p.m.
  
  
  CONCLUSIONS
  The all-cause readmission rate within 30 days of discharge after a pediatric neurosurgical procedure was 10.4%, and the rate of related readmission was 7.1%. Whether these readmissions are preventable and to what extent they are preventable requires further study.
authors.affiliation: Pediatric Neurosurgery Associates, Children's Healthcare of Atlanta;
authors.forename: Samir
authors.initials: S
authors.lastname: Sarda
authors.forename: Markus
authors.initials: M
authors.lastname: Bookland
authors.forename: Jason
authors.initials: J
authors.lastname: Chu
authors.forename: Mohammadali M
authors.initials: MM
authors.lastname: Shoja
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Miller
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Reisner
authors.forename: Philip H
authors.initials: PH
authors.lastname: Yun
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Chern
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019635:Neurosurgical Procedures; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
keywords: ACGME = Accreditation Council for Graduate Medical Education; CPT = current procedural terminology; ED = emergency department; ICP = intracranial pressure; ICU = intensive care unit; LOS = length of stay; NICU = neonatal ICU; PICU = pediatric ICU; VNS = vagus nerve stimulator; hydrocephalus; patient readmissions; quality assurance; reoperation