Good morning, everyone. My name is Andrew Koo. I am an incoming intern for the Department of Neurosurgery at Yale. I want to thank the Scientific Organizing Committee and AANS for giving us the opportunity to present this work, examining readmissions in the traumatic subdural hematoma population. The study was also published this month in World Neurosurgery, so I would like to thank the journal as well for the nice figures. In the past two decades, unplanned hospital readmissions have contributed significantly to the rapid rise in U.S. healthcare expenditures for patients and hospitals, leading to worse clinical outcomes, which are costly for public and private payers. In 2003 alone, nearly a fifth or 20% of Medicare patients were readmitted within 30 days, with 70% considered unplanned and unnecessary. This resulted in an estimated $17.4 billion healthcare expenditure. Therefore, it is imperative to identify patient factors associated with increased risk of unplanned readmissions, so as to decrease the growing readmission rates and soaring healthcare expenditure costs. Traumatic subdural hematoma is one of the most common forms of trauma-related intracranial hemorrhage and unfortunately remains one of the most impactful brain injuries. In the United States alone, cumulative costs have expanded two-fold from 1998 at $2.2 billion to $4.9 billion estimated in 2007. Previous studies have also shown that almost a third of acute traumatic subdural hematomas are readmitted, which increases the risk and costs leading to an increased burden on the healthcare system. The aim of this study was to investigate the similarities and differences in risk factors associated with 30- and 90-day readmissions, and we hypothesized that these risk factors specifically predicted hospital 30- and 90-day readmission after surgical intervention. This was a retrospective cohort study using the HCUP Nationwide Readmission Database. We used years 2013 to 2015 of that NRD for all patients undergoing incision of cerebral meninges for drainage of traumatic subdural hematoma, which included 14,355 identified patients. We then retrospectively assessed demographic information and hospital characteristics, comorbidities, complications, postoperative inpatient outcomes, and then the 30- and 90-day primary reasons for readmission. There were a total of 14,355 patients included in the study with 3,106 readmissions, 15.3% for 30-day readmissions and 6.3% for 31- to 90-day readmissions. Medicare tended to be in the largest percent of primary payer for the readmitted cohorts, while private insurers were greater in the non-readmission cohort. Most patients in all of the cohorts received care at metropolitan teaching hospitals. The most common patient comorbidities were hypertension, smoking, and diabetes. The rates of any complication were greater in the readmission cohorts compared with the non-readmitted cohort, and the most common inpatient complications were postoperative infection, epilepsy, and seizure. Both average length of stay and total cost for the index admissions were greater in the readmitted cohorts than the non-readmitted cohort. The non-readmitted cohort also had the highest percentage of routine discharges, while the 90-day readmission cohort had more discharges to skilled nursing, intermediate, or other facility care. The most prevalent 30- and 90-day complications seen among the readmitted cohorts were postoperative infection, sepsis, and epilepsy, followed by genitourinary complication and cerebral infarct. A multivariate regression analysis for 30-day hospital readmission, Medicare, Medicaid, hypertension, diabetes, renal failure, congestive heart failure, and coagulopathy during index admission were all independently associated with increased 30-day unplanned hospital readmission. On multivariate regression analysis for 31- to 90-day readmission, Medicare and rheumatoid arthritis or collagen vascular diseases during the index admission were independently associated with increased 31- to 90-day unplanned hospital readmission. In conclusion, we identify an unplanned readmission rate of 21.6% after treatment of traumatic subdural hematoma, with the most common drivers being infection, sepsis, and epilepsy-related complications. Furthermore, multiple patient-specific variables were associated with hospital readmission, and we hope that knowledge of these factors may help reduce the burden of unplanned hospital readmissions in the future. Thank you very much.

Andrew Koo

readmissions

traumatic subdural hematoma

patient factors

unplanned readmissions