Predictors and implications of 30-day readmissions following craniotomy for brain tumors: A systematic review and...

Thirty-day readmission rates are commonly used as quality indicators (QIs) due to their feasibility and financial impact on healthcare systems. However, their validity in neurosurgical oncology remains uncertain. This study evaluates 30-day readmission rates following craniotomies for brain tumor resection, focusing on causes, predictors, and their impact on overall survival (OS). A systematic review and meta-analysis were conducted following PRISMA guidelines. PubMed, Cochrane, Scopus, and Web of Science databases were queried for studies reporting 30-day readmission rates in craniotomies for brain tumors. Meta-analysis with random-effects modeling was performed for pooled readmission rates, causes, predictors, and survival outcomes. Individual patient data (IPD) for overall survival were available for glioblastoma patients from four studies and were reconstructed from Kaplan-Meier curves to assess the association between readmission and survival. Eleven studies involving 132,791 patients yielded a pooled 30-day readmission rate of 13% (95% CI: 11%-16%). Neurological (50%) and infectious (25%) causes were the most common readmission indications. Surgical site infections accounted for 11% (7%-16%) and thromboembolic events for 12% (9%-16%) of all readmissions. Preoperative characteristics, including functional status, were consistent predictors of readmission. Among glioblastoma patients, reconstructed IPD from four studies demonstrated that readmitted patients had significantly shorter median overall survival compared with non-readmitted patients (6.4 vs. 8.7 months, p < 0.0001). Thirty-day readmission rates provide insights into neurosurgical oncology care but have limitations as standalone QIs. A combination of QIs would offer a more comprehensive and accurate assessment of care quality. Efforts to reduce readmissions should address modifiable risk factors, such as preventing SSIs and thromboembolic events, and optimizing perioperative care.