Unplanned shunt readmission: what does it really look like?

Area of Science:

• Neurosurgery
• Pediatric Surgery
• Healthcare Outcomes Research

Background:

• Post-operative readmission after neurosurgical procedures, particularly shunt surgeries, is a significant concern.
• Understanding readmission drivers is crucial for improving patient care and resource allocation.

Purpose of the Study:

• To analyze the reasons for pediatric readmission after shunt surgery.
• To identify key patient characteristics and factors contributing to readmissions.

Main Methods:

• A single-institution administrative database of shunt surgeries from 2018-2021 was utilized.
• Included de novo or revision cranial shunt operations, with a 90-day follow-up period for each index case.
• Readmissions were categorized based on their relationship to the index surgery (unrelated, possibly related, directly related without reoperation, directly related with reoperation).

Main Results:

• The 90-day unplanned readmission rate was 20.7% (148/715 operations) in 139 pediatric patients.
• Factors associated with unrelated readmissions included public insurance, revision surgery, and prior neonatal intensive care unit (NICU) admission.
• Factors associated with directly related readmissions included private insurance, no prior NICU admission, and the specific surgeon performing the procedure.

Conclusions:

• The overall 90-day readmission rate following shunt surgery in children is approximately 21%.
• The specific drivers of readmission are dependent on the type of readmission, encompassing elements of socioeconomic status and hydrocephalus severity.