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J Neurosurg. 2016 Mar;124(3):743-9. doi: 10.3171/2015.2.JNS142771. Epub 2015 Sep 11.

Causes of 30-day readmission after aneurysmal subarachnoid hemorrhage.

Author information

1
Departments of 1 Neurological Surgery and.
2
Neurology, and.
3
Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri.

Abstract

OBJECTIVE:

Hospital readmission is a common but controversial quality measure increasingly used to influence hospital compensation in the US. The objective of this study was to evaluate the causes for 30-day hospital readmission following aneurysmal subarachnoid hemorrhage (SAH) to determine the appropriateness of this performance metric and to identify potential avenues for improved patient care.

METHODS:

The authors retrospectively reviewed the medical records of all patients who received surgical or endovascular treatment for aneurysmal SAH at Barnes-Jewish Hospital between 2003 and 2013. Two senior faculty identified by consensus the primary medical/surgical diagnosis associated with readmission as well as the underlying causes of rehospitalization.

RESULTS:

Among 778 patients treated for aneurysmal SAH, 89 experienced a total of 97 readmission events, yielding a readmission rate of 11.4%. The median time from discharge to readmission was 9 days (interquartile range 3-17.5 days). Actual hydrocephalus or potential concern for hydrocephalus (e.g., headache) was the most frequent diagnosis (26/97, 26.8%), followed by infections (e.g., wound infection [5/97, 5.2%], urinary tract infection [3/97, 3.1%], and pneumonia [3/97, 3.1%]) and thromboembolic events (8/97, 8.2%). In most cases (75/97, 77.3%), we did not identify any treatment lapses contributing to readmission. The most common underlying causes for readmission were unavoidable development of SAH-related pathology (e.g., hydrocephalus; 36/97, 37.1%) and complications related to neurological impairment and immobility (e.g., thromboembolic event despite high-dose chemoprophylaxis; 21/97, 21.6%). The authors determined that 22/97 (22.7%) of the readmissions were likely preventable with alternative management. In these cases, insufficient outpatient medical care (for example, for hyponatremia; 16/97, 16.5%) was the most common shortcoming.

CONCLUSIONS:

Most readmissions after aneurysmal SAH relate to late consequences of hemorrhage, such as hydrocephalus, or medical complications secondary to severe neurological injury. Although a minority of readmissions may potentially be avoided with closer medical follow-up in the transitional care environment, readmission after SAH is an insensitive and likely inappropriate hospital performance metric.

KEYWORDS:

BJH = Barnes-Jewish Hospital; CMS = Centers for Medicare and Medicaid Services; COPD = chronic obstructive pulmonary disease; DVT = deep vein thrombosis; IQR = interquartile range; SAH = subarachnoid hemorrhage; UTI = urinary tract infection; health care; hospital readmission; patient readmission; qualitative research; quality indicators; subarachnoid hemorrhage; vascular disorders

PMID:
26361278
PMCID:
PMC5729751
DOI:
10.3171/2015.2.JNS142771
[Indexed for MEDLINE]
Free PMC Article

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