Unplanned shunt readmission: what does it really look like?

Abstract

Objective: Readmission after an operation has garnered considerable attention within the neurosurgical literature. In this study, the authors sought to analyze the reasons why children are readmitted after shunt surgery and to identify key population characteristics and potential drivers.

Methods: The authors' single-institution shunt surgery administrative database was used to identify procedures performed from January 1, 2018, to December 31, 2021. Only de novo or revision cranial shunt operations were included. Each surgery within the database represents an index case, and each patient was followed for a 90-day period. The authors categorized an unplanned readmission after shunt surgery as falling into one of 4 groups: 1) definitely unrelated to the index surgery; 2) possibly related but ultimately deemed unrelated; 3) directly related but no return to the operating room; and 4) directly related and requiring repeat surgery. Groups 3 and 4 were combined for statistical purposes.

Results: A total of 715 shunt operations were performed with 148 (20.7%) unplanned readmissions within 90 days in 139 patients. The median age was 3.2 years with 58%, 53%, and 58% being male, Caucasian, and having some form of public health insurance, respectively. The majority of African-American children had government insurance (80%) compared to Caucasian (41%) and Hispanic/other (55%) children (p < 0.001). The proportion of new versus revision surgical procedures was 45% versus 55%. Surgeon C did the most operations (n = 52 [37%]). The median number of days to readmission and length of readmission were 26.5 (IQR 9.5-47.0) days and 3.0 (IQR confidence interval 1.0-5.0) days, respectively. Multinomial analysis found that public insurance, revision surgery, and prior admission to the neonatal intensive care unit (NICU) were associated with definitely unrelated readmissions. Private insurance, no prior NICU admission, and an individual surgeon were associated with directly related readmissions. Survival analyses showed no differences in time to readmission among all patients and among only those who had prior NICU admission.

Conclusions: The 90-day readmission rate after index shunt surgery was 21%. Drivers of readmission-including socioeconomic status and hydrocephalus severity-were a function of the type of readmission.