Dataset Information

Readmission after neurosurgical intervention in epilepsy: A nationwide cohort analysis.

ABSTRACT:

Objective

Hospital readmissions result in increased health care costs and are associated with worse outcomes after neurosurgical intervention. Understanding factors associated with readmissions will inform future studies aimed at improving quality of care in those with epilepsy.

Methods

Patients of all ages with epilepsy who underwent a neurosurgical intervention were identified in the 2014 Nationwide Readmissions Database, a nationally representative dataset containing data from roughly 17 million US hospital discharges. Diagnosis of epilepsy was based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)-based case definitions. Neurosurgical interventions for epilepsy: resective/disconnective surgery, responsive neurostimulation/deep brain stimulation, vagus nerve stimulation, radiosurgery, and intracranial electroencephalography were identified using ICD-9-CM procedure codes. Primary outcome was all-cause 30-day readmission following discharge from the index hospitalization.

Results

There were a total of 2284 index surgical admissions. Overall, 10.83% (n = 251) of patients following an index epilepsy surgery admission were readmitted within 30 days. Factors independently associated with 30-day readmission for all epilepsy surgery admissions were: Medicare insurance (P < .01), discharge disposition that was not home (P < .01), higher Elixhauser comorbidity indexes (P < .01), longer length of stay (P < .01), and adverse events of surgical and medical care during index stay (P = .04). In the multivariate model, Medicare insurance (hazard ratio [HR] 1.81 [1.29-2.53], P < .01) and length of stay (HR 1.02 [1.01-1.04], P < .01) remained significant independent predictors for 30-day readmission. The most common primary reason for readmissions was epilepsy/convulsions accounting for 22.85%.

Significance

Our results suggest that careful management of postoperative seizures and discharge planning after epilepsy surgery may be important to optimize outcomes and reduce the risk of readmission, particularly for patients on Medicare.

SUBMITTER: Kwon CS

PROVIDER: S-EPMC7227389 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Publications

Readmission after neurosurgical intervention in epilepsy: A nationwide cohort analysis.

Kwon Churl-Su CS Agarwal Parul P Subramaniam Varsha V Dhamoon Mandip M Mazumdar Madhu M Yeshokumar Anusha A Panov Fedor F Ghatan Saadi S Jetté Nathalie N

Epilepsia 20191202 1

<h4>Objective</h4>Hospital readmissions result in increased health care costs and are associated with worse outcomes after neurosurgical intervention. Understanding factors associated with readmissions will inform future studies aimed at improving quality of care in those with epilepsy.<h4>Methods</h4>Patients of all ages with epilepsy who underwent a neurosurgical intervention were identified in the 2014 Nationwide Readmissions Database, a nationally representative dataset containing data from ...[more]

PMID: 31792965

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Project description:OBJECTIVE:The effect of surgical treatment for supratentorial spontaneous intracerebral hemorrhage (ICH) and whether it is modified by key baseline characteristics and timing remains uncertain. METHODS:We performed a systematic review and meta-analysis of randomized controlled trials of surgical treatment of supratentorial spontaneous ICH aimed at clot removal. We searched MEDLINE, Embase, and Cochrane databases up to February 21, 2019. Primary outcome was good functional outcome at follow-up; secondary outcomes were death and serious adverse events. We analyzed all types of surgery combined and minimally invasive approaches separately. We pooled risk ratios with 95% confidence intervals and assessed the modifying effect of age, Glasgow Coma Scale, hematoma volume, and timing of surgery with meta-regression analysis. RESULTS:We included 21 studies with 4,145 patients; 4 (19%) were of the highest quality. Risk ratio of good functional outcome after any type of surgery was 1.40 (95% confidence interval [CI] =?1.22-1.60, I2 ?=?46%, 20 studies), and after minimally invasive surgery it was 1.47 (95% CI?=?1.26-1.72, I2 ?=?47%, 12 studies). For death, the risk ratio for any type of surgery was 0.77 (95% CI?=?0.68-0.85, I2 ?=?23%, 21 studies), and for minimally invasive surgery it was 0.68 (95% CI?=?0.56-0.83, I2 ?=?14%, 13 studies). Serious adverse events were reported infrequently. Surgery seemed more effective when performed sooner after symptom onset (p?=?0.04, 12 studies). Age, Glasgow Coma Scale, and hematoma volume did not modify the effect of surgery. INTERPRETATION:Surgical treatment of supratentorial spontaneous ICH may be beneficial, in particular with minimally invasive procedures and when performed soon after symptom onset. Further well-designed randomized trials are needed to demonstrate whether (minimally invasive) surgery improves functional outcome after ICH and to determine the optimal time window of the treatment after symptom onset. ANN NEUROL 2020;88:239-250.

Dataset Information

Readmission after neurosurgical intervention in epilepsy: A nationwide cohort analysis.

Objective

Methods

Results

Significance

Publications

Readmission after neurosurgical intervention in epilepsy: A nationwide cohort analysis.

Similar Datasets

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