Neurosurgical Economic and Readmission Trends After Extracranial Ventricular Shunts in the United States From 2009 to 2013

Background: The aim of the study was to define the association between federal payer insurance and neurosurgical economic trends and readmissions after extracranial ventricular shunts (EVS) procedures and investigate these trends from 2009 to 2013 in the United States. Methods: We identified the procedure of insertion, replacement, or removal of EVS by applying the International Classification of Disease, Ninth Edition, Clinical Modification (ICD-9-CM) Procedure Codes of 231-235, 239, 242 and 243. Data were extracted for years 2009 to 2013. Year-wise distributions of index stays, readmission, percent readmission, cost for index stays and cost for readmissions for patients requiring EVS procedures who possess Medicare insurance (ME-patients) and Medicaid insurance (MD-patients) were described. Z-test statistic was used to compare the two groups. Results: During the 5 years of study, we recorded 149,220 index stays and 29,655 readmissions within 30 days involving the procedures of insertion, replacement, or removal of an EVS. Throughout the study period, hospital readmissions involving patients requiring procedures involving EVS consistently demonstrated both the highest annual mean cost for readmissions and the highest percentage of patient readmissions in regard to all neurosurgical procedures. The differences between the annual index stays and readmissions for ME-patients versus MD-patients requiring EVS were extremely statistically significant throughout the entire study period (P < 0.0001, P < 0.0001). The mean cost of readmissions within 30 days for all patients varied significantly from $19,005 to $23,499, with an average cost of $21,279 for readmissions occurring annually during the study period (P = 0.0161). The differences between the mean cost for index stays and readmissions for ME-patients versus MD-patients requiring EVS were extremely statistically significant throughout the entire study period (P < 0.0001, P < 0.0001). Conclusions: Federal payer insurance has a significant association with neurosurgical economic and patient readmission trends after EVS procedures in hospitals in the US. Further study is needed to investigate the etiology of these differences between patients’ payer insurance and their impact on clinical outcomes after EVS procedures. J Neurol Res. 2020;10(4):122-126 doi: https://doi.org/10.14740/jnr600