J Neurosurg Spine Volume 24 • February 2016 281 literature review J Neurosurg Spine 24:281–290, 2016 I n the last 20 years, the burdens of readmission on the health care system, hospitals, patients, and insurers have become apparent. Estimates are that Medicare spends over $15 billion on readmission-related expen- ditures yearly. 21,32 Readmission can be infuenced by the quality of in-hospital care as well as follow-up care in the community, among other factors. 17 Compared with the US, in Canada, the interest in readmission is still growing. A recent report on readmissions by Health Canada found the current 28-day readmission rate for acute myocardial infarction to be concerning. 17 Rates of readmission were 6.2% in 2003–2004 to 2005–2006, 4.4% in 2007–2008 to 2009–2010, and 4.1% for 2008–2009 to 2010–2011. Ac- cording to this report, readmission rates are considered important factors for measuring the quality and effciency of acute care. The report also called the need for reduc- ing readmission rates a public health priority. Multifaceted interventions are now provided by health care profession- als, which have been shown to be effective in readmission rate reductions. 17 With multiple programs concerned with improvement of quality of care and readmission being viewed as an indicator of hospital performance, readmis- sion after discharge has become a principal target for cost reduction. 21 In the United States, 30-day readmission after dis- charge is an important indicator of health care quality in abbreviatioNS ASA = American Society of Anesthesiologists; CPT = Current Procedural Terminology; DVT = deep vein thrombosis; LOS = length of stay; PCI = percu- taneous coronary intervention; PE = pulmonary embolism; PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses; SSI = surgical site infection; UTI = urinary tract infection. Submitted January 2, 2015. accepted April 15, 2015. iNclude wheN citiNg Published online October 9, 2015; DOI: 10.3171/2015.4.SPINE15445. Causes of 30-day readmission after neurosurgery of the spine michael d. cusimano, md, phd, 1,2 iryna pshonyak, bSc, 1 michael Y. lee, 1 and gabriela ilie, phd 1 1 Division of Neurosurgery, Keenan Research Centre and Li Ka Shing Knowledge Institute, St. Michael’s Hospital; and 2 Dalla Lana School of Public Health and Department of Surgery, University of Toronto, Ontario, Canada obJective Thirty-day readmission has been cited as an important indicator of the quality of care in several felds of medicine. The aim of this systematic review was to examine rate of readmission and factors relevant to readmission after neurosurgery of the spine. methodS The authors carried out a systematic review using several databases, searches of cited reference lists, and a manual search of the JNS Publishing Group journals ( Journal of Neurosurgery; Journal of Neurosurgery: Spine; Jour- nal of Neurosurgery: Pediatrics; and Neurosurgical Focus) , Neurosurgery , Acta Neurochirurgica, and Canadian Journal of Neurological Sciences. A quality review was performed using STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) criteria and reported according to the PRISMA (Preferred Reporting Items for Systematic Re- views and Meta-Analyses) guidelines. reSultS A systematic review of 1136 records published between 1947 and 2014 revealed 31 potentially eligible stud- ies, and 5 studies met inclusion criteria for content and quality. Readmission rates varied from 2.54% to 14.7%. Sequelae that could be traced back to complications that arose during neurosurgery of the spine were a prime reason for readmis- sion after discharge. Increasing age, poor physical status, and comorbid illnesses were also important risk factors for 30-day readmission. coNcluSioNS Readmission rates have predictable factors that can be addressed. Strategies to reduce readmission that relate to patient-centered factors, complication avoidance during neurosurgery, standardization with system-wide protocols, and moving toward a culture of nonpunitive system-wide error and “near miss” investigations and quality im- provement are discussed. http://thejns.org/doi/abs/10.3171/2015.4.SPINE15445 KeY wordS readmission; spine; systematic review; neurosurgery; outcomes ©AANS, 2016 Unauthenticated | Downloaded 07/27/22 04:56 PM UTC