The Rate and Predictors of 30-Day Readmission in Patients Treated for Unruptured Cerebral Aneurysms: A Large Single-Center Study.


Journal

Neurosurgery
ISSN: 1524-4040
Titre abrégé: Neurosurgery
Pays: United States
ID NLM: 7802914

Informations de publication

Date de publication:
01 12 2023
Historique:
received: 02 05 2023
accepted: 09 07 2023
medline: 16 11 2023
pubmed: 8 9 2023
entrez: 8 9 2023
Statut: ppublish

Résumé

Numerous studies of various populations and diseases have shown that unplanned 30-day readmission rates are positively correlated with increased morbidity and all-cause mortality. In this study, we aim to provide the rate and predictors of 30-day readmission in patients undergoing treatment for unruptured intracranial aneurysms. This is a retrospective study of 525 patients presenting for aneurysm treatment between 2017 and 2022. All patients who were admitted and underwent a successful treatment of their unruptured intracerebral aneurysms were included in the study. The primary outcome was the rate and predictors of 30-day readmission. The rate of 30-day readmission was 6.3%, and the mean duration to readmission was 7.8 days ± 6.9. On univariate analysis, factors associated with 30-day readmission were antiplatelet use on admission (odds ratio [OR]: 0.4, P = .009), peri-procedural rupture (OR: 15.8, P = .007), surgical treatment of aneurysms (OR: 2.2, P = .035), disposition to rehabilitation (OR: 9.5, P < .001), and increasing length of stay (OR: 1.1, P = .0008). On multivariate analysis, antiplatelet use on admission was inversely correlated with readmission (OR: 0.4, P = .045), whereas peri-procedural rupture (OR: 9.5, P = .04) and discharge to rehabilitation (OR: 4.5, P = .029) were independent predictors of 30-day readmission. In our study, risk factors for 30-day readmission were aneurysm rupture during the hospital stay and disposition to rehabilitation, whereas the use of antiplatelet on admission was inversely correlated with 30-day readmission. Although aneurysm rupture is a nonmodifiable risk factor, more studies are encouraged to focus on the correlation of antiplatelet use and rehabilitation disposition with 30-day readmission rates.

Sections du résumé

BACKGROUND AND OBJECTIVES
Numerous studies of various populations and diseases have shown that unplanned 30-day readmission rates are positively correlated with increased morbidity and all-cause mortality. In this study, we aim to provide the rate and predictors of 30-day readmission in patients undergoing treatment for unruptured intracranial aneurysms.
METHODS
This is a retrospective study of 525 patients presenting for aneurysm treatment between 2017 and 2022. All patients who were admitted and underwent a successful treatment of their unruptured intracerebral aneurysms were included in the study. The primary outcome was the rate and predictors of 30-day readmission.
RESULTS
The rate of 30-day readmission was 6.3%, and the mean duration to readmission was 7.8 days ± 6.9. On univariate analysis, factors associated with 30-day readmission were antiplatelet use on admission (odds ratio [OR]: 0.4, P = .009), peri-procedural rupture (OR: 15.8, P = .007), surgical treatment of aneurysms (OR: 2.2, P = .035), disposition to rehabilitation (OR: 9.5, P < .001), and increasing length of stay (OR: 1.1, P = .0008). On multivariate analysis, antiplatelet use on admission was inversely correlated with readmission (OR: 0.4, P = .045), whereas peri-procedural rupture (OR: 9.5, P = .04) and discharge to rehabilitation (OR: 4.5, P = .029) were independent predictors of 30-day readmission.
CONCLUSION
In our study, risk factors for 30-day readmission were aneurysm rupture during the hospital stay and disposition to rehabilitation, whereas the use of antiplatelet on admission was inversely correlated with 30-day readmission. Although aneurysm rupture is a nonmodifiable risk factor, more studies are encouraged to focus on the correlation of antiplatelet use and rehabilitation disposition with 30-day readmission rates.

Identifiants

pubmed: 37681971
doi: 10.1227/neu.0000000000002663
pii: 00006123-990000000-00869
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

1415-1424

Informations de copyright

Copyright © Congress of Neurological Surgeons 2023. All rights reserved.

Références

Shaw JA, Stiliannoudakis S, Qaiser R, Layman E, Sima A, Ali A. Thirty-day hospital readmissions: a predictor of higher all-cause mortality for up to two years. Cureus 2020;12(7):e9308.
Weiss AJ, Jiang HJ. Overview of Clinical Conditions With Frequent and Costly Hospital Readmissions by Payer, 2018. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Agency for Healthcare Research and Quality (US); 2006.
Liu HJ, Zhou H, Lu DL, et al. Intracranial mirror aneurysm: epidemiology, rupture risk, new imaging, controversies, and treatment strategies. World Neurosurg. 2019;127:165-175.
Quinn TJ, Dawson J, Walters MR, Lees KR. Reliability of the modified Rankin Scale: a systematic review. Stroke. 2009;40(10):3393-3395.
Darflinger R, Thompson LA, Zhang Z, Chao K. Recurrence, retreatment, and rebleed rates of coiled aneurysms with respect to the Raymond-Roy scale: a meta-analysis. J NeuroInterventional Surg. 2016;8(5):507-511.
Mehta T, Desai N, Patel S, et al. Readmission trends related to unruptured intracranial aneurysm treatment. Front Neurol. 2021;12:590751.
Bekelis K, Missios S, MacKenzie TA. Continuity of care and 30-day readmission for patients evaluated in the emergency room after cerebral aneurysm treatment. J Neurointerv Surg. 2016;8(11):1203-1206.
Dasenbrock HH, Angriman F, Smith TR, et al. Readmission after aneurysmal subarachnoid hemorrhage: a nationwide readmission database analysis. Stroke. 2017;48(9):2383-2390.
Hoffman H, Protas M, Chin LS. A Nationwide analysis of 30-day and 90-day readmissions after elective cerebral aneurysm clipping in the United States: causes, predictors, and trends. World Neurosurg. 2019;128:e873-e883.
Hoffman H, Protas M, Chin LS. Causes, predictors, and trends of unplanned readmissions after elective endovascular embolization of cerebral aneurysms. J Stroke Cerebrovasc Dis. 2019;28(11):104396.
Rumalla K, Smith KA, Arnold PM, Mittal MK. Subarachnoid hemorrhage and readmissions: national rates, causes, risk factors, and outcomes in 16,001 hospitalized patients. World Neurosurg. 2018;110:e100-e111.
Dasenbrock HH, Smith TR, Rudy RF, Gormley WB, Aziz-Sultan MA, Du R. Reoperation and readmission after clipping of an unruptured intracranial aneurysm: a National Surgical Quality Improvement Program analysis. J Neurosurg. 2018;128(3):756-767.
Niu PP, Guo ZN, Jin H, Xing YQ, Yang Y. Antiplatelet regimens in the long-term secondary prevention of transient ischaemic attack and ischaemic stroke: an updated network meta-analysis. BMJ Open. 2016;6(3):e009013.
Claassen J, Park S. Spontaneous subarachnoid haemorrhage. Lancet. 2022;400(10355):846-862.
Vivancos J, Gilo F, Frutos R, et al. Clinical management guidelines for subarachnoid haemorrhage. Diagnosis and treatment. Neurologia. 2014;29(6):353-370.
Vermeij FH, Hasan D, Bijvoet HW, Avezaat CJ. Impact of medical treatment on the outcome of patients after aneurysmal subarachnoid hemorrhage. Stroke. 1998;29(5):924-930.

Auteurs

Kareem El Naamani (K)

Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia , Pennsylvania , USA.

Adam Hunt (A)

Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia , Pennsylvania , USA.

Paarth Jain (P)

Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia , Pennsylvania , USA.

Charles L Lawall (CL)

Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia , Pennsylvania , USA.

Clifford J Yudkoff (CJ)

Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia , Pennsylvania , USA.

Omar El Fadel (O)

Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia , Pennsylvania , USA.

Marc Ghanem (M)

Gilbert and Rose-Marie Chaghoury School of Medicine, Lebanese American University, Byblos , Lebanon.

Panagiotis Mastorakos (P)

Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia , Pennsylvania , USA.

Arbaz A Momin (AA)

Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia , Pennsylvania , USA.

Abdulaziz Alhussein (A)

Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia , Pennsylvania , USA.

Reyoof Alhussein (R)

Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia , Pennsylvania , USA.

Elias Atallah (E)

Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia , Pennsylvania , USA.

Rawad Abbas (R)

Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia , Pennsylvania , USA.

Rida Zakar (R)

School of Medicine, Saint Joseph University, Beirut , Lebanon.

Stavropoula I Tjoumakaris (SI)

Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia , Pennsylvania , USA.

M Reid Gooch (MR)

Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia , Pennsylvania , USA.

Nabeel A Herial (NA)

Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia , Pennsylvania , USA.

Hekmat Zarzour (H)

Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia , Pennsylvania , USA.

Richard F Schmidt (RF)

Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia , Pennsylvania , USA.

Robert H Rosenwasser (RH)

Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia , Pennsylvania , USA.

Pascal M Jabbour (PM)

Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia , Pennsylvania , USA.

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