Authors: Emily Harmer; Sarah Peacock; Ami Grek; W David Freeman, MD; Launia White, BS; Tonja Hartjes; James Naessens (Jacksonville, FL)
Readmissions within 30 days of hospitalization are utilized as a quality of care benchmark. We reviewed 30 day hospital readmissions for Neuroscience patients over 4 years at Mayo Clinic.
We conducted a Mayo Clinic Kern Center for Science of Health Care Delivery retrospective analysis reviewing neurosurgery patients who were readmitted to the hospital within 30 days. The following data points were utilized in the review: age, sex, length of stay, Charlson comorbidity index, ICU stay, elective or urgent surgery, and discharge disposition.
All patients were reviewed from January 2013 to December 2017, totaling 3966 patients that were not readmitted and 295 (6.9%) patients that were unplanned readmissions within 30 days. Factors associated with readmission included: increased length of stay (p<0.0001, mean 5.4 days (SD 6.8) versus 3.8 (SD 4.5), Charlson comorbidity myocardial infarct, congestive heart failure, peripheral vascular disease, cerebrovascular disease (p<0.0001), dementia (p<0.0001), chronic pulmonary disease (p<0.0001), ulcer, diabetes (p<0.0001), hemiplegia (p<0.0001), moderate or severe renal disease, metastatic solid tumor (p<0.0001), other cancer (p<0.0001), brain/nervous system tumor (p<0.0001), total disease flag count (p<0.0001), ICU stay (p<0.0001), discharge to skilled nursing facility or rehabilitation facility (p<0.0001). Factors without statistical significance included: age, sex, mild liver disease, AIDS, rheumatic disease.
This study has the largest total sample size examining neuroscience patient risk factors for readmission. This data suggests that patients with more comorbidities or decreased functional ability are associated with readmissions. This analysis is the basis for a future a prospective multivariate regression model to quantify readmission risk in neuroscience patients to guide future interventions.