Return to system within 30 days of discharge following pediatric shunt surgery: Clinical article

Joshua J. Chern, Markus Bookland, Javier Tejedor-Sojo, Jonathan Riley, Mohammadali Mohajel Shoja, R. Shane Tubbs, Andrew Reisner

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Object. The rate of readmission after CSF shunt surgery is significant and has caught the attention of purchasers of health care. However, a detailed description of clinical scenarios that lead to readmissions and reoperations after index shunt surgery is lacking in the medical literature. Methods. This study included 1755 shunt revision and insertion surgeries that were performed at a single institution between May 1, 2009, and April 30, 2013. Demographic, socioeconomic, and clinical characteristics were prospectively collected in the administrative, business, and operating room databases. Clinical events within the 30 days following discharge were reviewed and analyzed. Two events of interest, Emergency Department (ED) utilization and reoperation, were further analyzed for risk factor associations by using multivariate logistic regression. Results. There were 290 readmissions within 30 days of discharge (16.5%). Admission sources included ED (n = 216), hospital transfers (n = 23), and others. Of the 290 readmissions, 184 were associated with an operation, but only 165 of these were performed by the neurosurgical service. These included surgeries for shunt occlusion and externalization (n = 150), wound revision (n = 7), and other neurosurgical procedures that were not shunt related (n = 8). The remaining readmissions (n = 106) were not associated with an operation, and only 59 patients were admitted for issues related to the index shunt surgery. When return to the ED was the dependent variable in a multivariate regression model, patients who returned to the ED were more likely to be from the Atlanta metropolitan area and to be either uninsured or insured with public assistance. When reoperation was the dependent variable, patients whose surgery started after 3 p.m. were more likely to undergo subsequent CSF shunt revision surgery on readmission. Conclusions. Of the readmissions within 30 days of shunt surgery, 74.5% were related to the index shunt surgery. Whether and to what extent these readmissions are preventable continues to be controversial. Further study is needed to identify modifiable risk factors that may eventually improve patient care.

Original languageEnglish (US)
Pages (from-to)525-531
Number of pages7
JournalJournal of Neurosurgery: Pediatrics
Volume13
Issue number5
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Fingerprint

Reoperation
Pediatrics
Hospital Emergency Service
Public Assistance
Neurosurgical Procedures
Operating Rooms
Ambulatory Surgical Procedures
Patient Care
Logistic Models
Demography
Databases
Delivery of Health Care
Wounds and Injuries

Keywords

  • Administrative claims data
  • Cerebrospinal fluid shunt
  • Hospital readmission
  • Hydrocephalus
  • Quality control

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology

Cite this

Chern, J. J., Bookland, M., Tejedor-Sojo, J., Riley, J., Mohajel Shoja, M., Tubbs, R. S., & Reisner, A. (2014). Return to system within 30 days of discharge following pediatric shunt surgery: Clinical article. Journal of Neurosurgery: Pediatrics, 13(5), 525-531. https://doi.org/10.3171/2014.2.PEDS13493

Return to system within 30 days of discharge following pediatric shunt surgery : Clinical article. / Chern, Joshua J.; Bookland, Markus; Tejedor-Sojo, Javier; Riley, Jonathan; Mohajel Shoja, Mohammadali; Tubbs, R. Shane; Reisner, Andrew.

In: Journal of Neurosurgery: Pediatrics, Vol. 13, No. 5, 01.01.2014, p. 525-531.

Research output: Contribution to journalArticle

Chern, JJ, Bookland, M, Tejedor-Sojo, J, Riley, J, Mohajel Shoja, M, Tubbs, RS & Reisner, A 2014, 'Return to system within 30 days of discharge following pediatric shunt surgery: Clinical article', Journal of Neurosurgery: Pediatrics, vol. 13, no. 5, pp. 525-531. https://doi.org/10.3171/2014.2.PEDS13493
Chern, Joshua J. ; Bookland, Markus ; Tejedor-Sojo, Javier ; Riley, Jonathan ; Mohajel Shoja, Mohammadali ; Tubbs, R. Shane ; Reisner, Andrew. / Return to system within 30 days of discharge following pediatric shunt surgery : Clinical article. In: Journal of Neurosurgery: Pediatrics. 2014 ; Vol. 13, No. 5. pp. 525-531.
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abstract = "Object. The rate of readmission after CSF shunt surgery is significant and has caught the attention of purchasers of health care. However, a detailed description of clinical scenarios that lead to readmissions and reoperations after index shunt surgery is lacking in the medical literature. Methods. This study included 1755 shunt revision and insertion surgeries that were performed at a single institution between May 1, 2009, and April 30, 2013. Demographic, socioeconomic, and clinical characteristics were prospectively collected in the administrative, business, and operating room databases. Clinical events within the 30 days following discharge were reviewed and analyzed. Two events of interest, Emergency Department (ED) utilization and reoperation, were further analyzed for risk factor associations by using multivariate logistic regression. Results. There were 290 readmissions within 30 days of discharge (16.5{\%}). Admission sources included ED (n = 216), hospital transfers (n = 23), and others. Of the 290 readmissions, 184 were associated with an operation, but only 165 of these were performed by the neurosurgical service. These included surgeries for shunt occlusion and externalization (n = 150), wound revision (n = 7), and other neurosurgical procedures that were not shunt related (n = 8). The remaining readmissions (n = 106) were not associated with an operation, and only 59 patients were admitted for issues related to the index shunt surgery. When return to the ED was the dependent variable in a multivariate regression model, patients who returned to the ED were more likely to be from the Atlanta metropolitan area and to be either uninsured or insured with public assistance. When reoperation was the dependent variable, patients whose surgery started after 3 p.m. were more likely to undergo subsequent CSF shunt revision surgery on readmission. Conclusions. Of the readmissions within 30 days of shunt surgery, 74.5{\%} were related to the index shunt surgery. Whether and to what extent these readmissions are preventable continues to be controversial. Further study is needed to identify modifiable risk factors that may eventually improve patient care.",
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N2 - Object. The rate of readmission after CSF shunt surgery is significant and has caught the attention of purchasers of health care. However, a detailed description of clinical scenarios that lead to readmissions and reoperations after index shunt surgery is lacking in the medical literature. Methods. This study included 1755 shunt revision and insertion surgeries that were performed at a single institution between May 1, 2009, and April 30, 2013. Demographic, socioeconomic, and clinical characteristics were prospectively collected in the administrative, business, and operating room databases. Clinical events within the 30 days following discharge were reviewed and analyzed. Two events of interest, Emergency Department (ED) utilization and reoperation, were further analyzed for risk factor associations by using multivariate logistic regression. Results. There were 290 readmissions within 30 days of discharge (16.5%). Admission sources included ED (n = 216), hospital transfers (n = 23), and others. Of the 290 readmissions, 184 were associated with an operation, but only 165 of these were performed by the neurosurgical service. These included surgeries for shunt occlusion and externalization (n = 150), wound revision (n = 7), and other neurosurgical procedures that were not shunt related (n = 8). The remaining readmissions (n = 106) were not associated with an operation, and only 59 patients were admitted for issues related to the index shunt surgery. When return to the ED was the dependent variable in a multivariate regression model, patients who returned to the ED were more likely to be from the Atlanta metropolitan area and to be either uninsured or insured with public assistance. When reoperation was the dependent variable, patients whose surgery started after 3 p.m. were more likely to undergo subsequent CSF shunt revision surgery on readmission. Conclusions. Of the readmissions within 30 days of shunt surgery, 74.5% were related to the index shunt surgery. Whether and to what extent these readmissions are preventable continues to be controversial. Further study is needed to identify modifiable risk factors that may eventually improve patient care.

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