title: Unplanned readmissions and survival following brain tumor surgery.
abstract: OBJECTIVE
  Research on readmissions has been influenced by efforts to reduce hospital cost and avoid penalties stipulated by the Centers for Medicare and Medicaid Services. Less emphasis has been placed on understanding these readmissions and their impact on patient outcomes. This study 1) delineates reasons for readmission, 2) explores factors associated with readmissions, and 3) describes their impact on the survival of glioblastoma patients.
  
  
  METHODS
  The authors conducted a retrospective review of 362 cases involving patients with glioblastoma undergoing biopsy or tumor resection at their institution between 2003 and 2011. Reasons for re-hospitalization were characterized according to whether or not they were related to surgery and considered preventable. Multivariate analyses were conducted to identify the effect of readmission on survival and determine factors associated with re-hospitalizations.
  
  
  RESULTS
  Twenty-seven (7.5%) of 362 patients experienced unplanned readmissions within 30 days of surgery. Six patients (22.2%) were readmitted by Day 7, 14 (51.9%) by Day 14, and 20 (74.1%) by Day 21. Neurological, infectious, and thromboembolic complications were leading reasons for readmission, accounting for, respectively, 37.0%, 29.6%, and 22.2% of unplanned readmissions. Twenty-one (77.8%) of the 27 readmissions were related to surgery and 19 (70.4%) were preventable. The adjusted hazard ratio of mortality associated with a readmission was 2.03 (95% CI 1.3-3.1). Higher-functioning patients (OR 0.96, 95% CI 0.9-1.0) and patients discharged home (OR 0.21, 95% CI 0.1-0.6) were less likely to get readmitted.
  
  
  CONCLUSIONS
  An overwhelming fraction of documented unplanned readmissions were considered preventable and related to surgery. Patients who were readmitted to the hospital within 30 days of surgery had twice the risk of mortality compared with patients who were not readmitted.
authors.affiliation: Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Holly
authors.initials: H
authors.lastname: Dickinson
authors.forename: Christine
authors.initials: C
authors.lastname: Carico
authors.forename: Miriam
authors.initials: M
authors.lastname: Nuño
authors.forename: Debraj
authors.initials: D
authors.lastname: Mukherjee
authors.forename: Alicia
authors.initials: A
authors.lastname: Ortega
authors.forename: Keith L
authors.initials: KL
authors.lastname: Black
authors.forename: Chirag G
authors.initials: CG
authors.lastname: Patil
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: DVT = deep venous thrombosis; HR = hazard ratio; KPS = Karnofsky Performance Status; LOS = length of hospital stay; PE = pulmonary embolism; SOI = severity of illness; SSI = surgical site infection; UTI = urinary tract infection; VTE = venous thromboembolism; complications; functional status; glioblastoma; oncology; unplanned readmission