title: Emergency department evaluation and 30-day readmission after craniotomy for primary brain tumor resection in New York State.
abstract: OBJECTIVE Fragmentation of care has been recognized as a major contributor to 30-day readmissions after surgical procedures. The authors investigated the association of evaluation in the hospital where the original procedure was performed with the rate of 30-day readmissions for patients presenting to the emergency department (ED) after craniotomy for primary brain tumor resection. METHODS A cohort study was conducted, involving patients who were evaluated in the ED within 30 days after discharge following a craniotomy for primary brain tumor resection between 2009 and 2013, and who were registered in the Statewide Planning and Research Cooperative System (SPARCS) database of New York State. A propensity score-adjusted model was used to control for confounding, whereas a mixed-effects model accounted for clustering at the hospital level. RESULTS Of the 610 patients presenting to the ED, 422 (69.2%) were evaluated in a hospital different from the one where the original procedure was performed (28.9% were readmitted), and 188 (30.8%) were evaluated at the original hospital (20.3% were readmitted). In a multivariable analysis, the authors demonstrated that being evaluated in the ED of the original hospital was associated with a decreased rate of 30-day readmission (OR 0.64, 95% CI 0.41-0.98). Similar associations were found in a mixed-effects logistic regression model (OR 0.63, 95% CI 0.40-0.96) and a propensity score-adjusted model (OR 0.64, 95% CI 0.41-0.98). This corresponds to one less readmission per 12 patients evaluated in the hospital where the original procedure was performed. CONCLUSIONS Using a comprehensive all-payer cohort of patients in New York State who were evaluated in the ED after craniotomy for primary brain tumor resection, the authors identified an association of assessment in the hospital where the original procedure was performed with a lower rate of 30-day readmissions. This underscores the potential importance of continuity of care in readmission prevention for these patients.
authors.affiliation: 1Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana.
authors.forename: Symeon
authors.initials: S
authors.lastname: Missios
authors.affiliation: 2Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon.|3Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.|4The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon; and.
authors.forename: Kimon
authors.initials: K
authors.lastname: Bekelis
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000601:surgery*; D003266:Continuity of Patient Care; D003399:Craniotomy / Q000009:adverse effects*; D016208:Databases, Factual; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York; D010359:Patient Readmission; D011183:Postoperative Complications / Q000175:diagnosis*
keywords: CHF = congestive heart failure; ED = emergency department; ICD-9-CM = International Classification of Diseases, Ninth Revision, Clinical Modification; SPARCS; SPARCS = Statewide Planning and Research Cooperative System; continuity of care; craniotomy; emergency department evaluation; oncology; primary tumor resection; readmissions