Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany.
Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany.
World Neurosurg. 2021 May;149:e622-e635. doi: 10.1016/j.wneu.2021.01.123. Epub 2021 Feb 3.
A better understanding of the risks and reasons for unplanned readmission is an essential component in reducing costs in the health care system and in optimizing patient safety and satisfaction. The reasons for unplanned readmission vary between different disciplines and procedures. The aim of this study was to identify reasons for readmission in view of different diagnoses in cranial neurosurgery.
In this single-center retrospective study, adult patients after neurosurgical treatment were analyzed and grouped according to the indication based on International Classification of Diseases and Related Health Problems, Tenth Revision, German Modification diagnosis codes. The main outcome measure was unplanned readmission within 30 days of discharge. Further logistic regression models were performed to identify factors associated with unplanned rehospitalization.
Of the 2474 patients analyzed, 183 underwent unplanned rehospitalization. Readmission rates differed between the diagnosis groups, with 9.19% in neoplasm, 8.26% in hydrocephalus, 5.76% in vascular, 6.13% after trauma, and 8.05% in the functional group. Several causes were considered to be preventable, such as wound healing disorders, seizures, or social reasons. Younger age, length of first stay, surgical treatment, and side diagnoses were predictors for unplanned readmission. Diagnoses with an increased risk of readmission were glioblastoma, traumatic subdural hematoma, or chronic subdural hematoma.
Reasons and predictors for an unplanned readmission differ considerably among the index diagnosis groups. In addition to well-known reasons for readmission, we identified social indication, meaning a lack of home care, which is particularly prevalent in oncologic and elderly patients. A transitional care program could benefit these vulnerable patients.
深入了解计划外再入院的风险和原因，是降低医疗保健系统成本和优化患者安全与满意度的重要组成部分。导致计划外再入院的原因因不同学科和手术而有所不同。本研究旨在根据颅神经外科学的不同诊断来确定再入院的原因。
在这项单中心回顾性研究中，根据国际疾病分类和相关健康问题第十次修订版德国修正诊断代码，对接受神经外科治疗的成年患者进行分析和分组。主要观察指标为出院后 30 天内的非计划性再入院。进一步进行逻辑回归模型，以确定与非计划性再入院相关的因素。
在分析的 2474 例患者中，有 183 例发生了非计划性再入院。不同诊断组的再入院率存在差异，肿瘤组为 9.19%，脑积水组为 8.26%，血管组为 5.76%，创伤组为 6.13%，功能组为 8.05%。一些原因被认为是可以预防的，例如伤口愈合障碍、癫痫发作或社会原因。年龄较小、首次住院时间较长、手术治疗和并存诊断是计划外再入院的预测因素。再入院风险增加的诊断包括胶质母细胞瘤、创伤性硬膜下血肿或慢性硬膜下血肿。
导致计划外再入院的原因在索引诊断组之间存在显著差异。除了众所周知的再入院原因外，我们还发现了社会指征，即缺乏家庭护理，这在肿瘤和老年患者中尤为普遍。过渡性护理方案可能使这些脆弱患者受益。
