Background

A shift in how we evaluate healthcare outcomes has driven the introduction of quality indicators as potential parameters to evaluate value-based healthcare delivery. So far, only few studies have been performed evaluating quality indicators in the context of neurosurgery, especially in the European region. The purpose of this study was to evaluate the 30-day readmission rate, identify reasons for readmission regarding the various neurosurgical diagnoses, and discuss the usefulness of this rate as a potential quality indicator.

Methods

During a 6-year period, a total of 8878 hospitalized patients in our neurosurgical department were retrospectively analyzed and included in this study. Reasons for readmission were identified. Patients’ diagnoses and baseline characteristics were obtained in order to identify possible risk factors for readmission.

Results

The 30-day readmission rate was 2.9%. The most common reason for unplanned readmissions were surgical site infections. The reasons for readmissions varied significantly between the different underlying neurosurgical diseases (p < 0.001). Multivariate logistic regression revealed hydrocephalus (OR, 4) and shorter length of stay during index admission (OR, 0.9) as risk factors for readmission.

Conclusions

We provided an analysis of reasons for readmission for various neurosurgical diseases in a large patient spectrum in Germany. Although readmission rates are easy to track and an attractive tool for quality assessment, the rate alone cannot be seen as an adequate measure for quality in neurosurgery as it lacks a homogenous definition and depends on the underlying health care system. In addition, strategies for risk adjustment are required.

中文翻译：

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神经外科手术的30天再入院率是质量评估的有用指标吗？

背景

我们评估医疗保健结果的方式发生了变化，促使引入质量指标作为评估基于价值的医疗保健交付的潜在参数。迄今为止，在神经外科手术方面，尤其是在欧洲地区，很少有研究评估质量指标。这项研究的目的是评估30天的再入院率，确定有关各种神经外科诊断的再入院原因，并讨论该比率作为潜在质量指标的有用性。

方法

在6年的时间里，对我们神经外科的总共8878例住院患者进行了回顾性分析，并将其纳入本研究。确定了再次入院的原因。获得患者的诊断和基线特征，以识别再次入院的可能危险因素。

结果

30天的再入院率为2.9％。意外入院的最常见原因是手术部位感染。在不同的基础神经外科疾病之间，再次入院的原因差异很大（p  <0.001）。多元logistic回归显示脑积水（OR，4）和指数入院时住院时间短（OR，0.9）是再次入院的危险因素。

结论

我们分析了德国大量患者因各种神经外科疾病而再次入院的原因。尽管再入院率易于追踪，并且是进行质量评估的有吸引力的工具，但是再入院率缺乏统一的定义，并依赖于基础医疗体系，因此不能被视为神经外科手术质量的适当衡量标准。另外，需要风险调整策略。