Nationwide Readmission Rates and Hospital Charges for Patients With Surgical Evacuation of Nontraumatic Subdural Hematomas: Part 1-Craniotomy

Association between interhospital transfer status and outcomes following nontraumatic subdural hemorrhage

BACKGROUND

Patients with nontraumatic subdural hemorrhage often require immediate surgical intervention that may not be available at community hospitals and are therefore transferred to tertiary care centers. This study aims to evaluate the effects of interhospital transfer (IHT) on postoperative complications and outcomes following ntSDH.

METHODS

The National Surgical Quality Improvement Program (NSQIP) database was queried for patients treated for ntSDH from January 2014 to January 2020. Baseline demographics, clinical characteristics, postoperative complications, and postoperative outcomes compared based on IHT status. Univariate and multivariate logistic regression analyses were performed. Effect sizes in the final model were presented as odds ratio (OR) with associated 95% confidence interval (CI).

RESULTS

Of the 715 included patients, 295 (41.3 %) were in the IHT cohort. Non-IHT patients demonstrated significantly increased progressive renal insufficiency (1.90 % vs 0.00 %, p = 0.043) and 30-day readmission rates (11.9 % vs 6.10 %, p = 0.003) when compared with IHT patients. IHT was associated with significantly increased odds of postoperative sepsis (OR = 1.37, p = 0.009), 30-day mortality (OR = 1.20, p = 0.011), and non-home disposition (OR = 1.14, p = 0.003).

CONCLUSIONS

Despite similar baseline characteristics, patients transferred for ntSDH treatment are associated with worse postoperative outcomes. Future studies should be conducted to identifying specific factors associated with IHT and poor outcomes.

Middle meningeal artery embolization with surgical evacuation improves outcomes in chronic subdural hematoma: a multi-institutional and multinational database study

BACKGROUND

Middle meningeal artery embolization (MMAE) is emerging as a promising adjunctive treatment in patients with chronic subdural hematomas (cSDH). This study presents real world multicenter data comparing outcomes in cSDH patients undergoing surgical treatment alone or combined with MMAE.

METHODS

This multi-institutional, multinational, retrospective, propensity-matched study utilized the TriNetX platform to compare outcomes in patients undergoing surgical evacuation and MMAE versus surgery alone for cSDH. The outcomes included inpatient readmission, need for repeat surgery, and mortality at 6 months following treatment.

RESULTS

Among 253 108 patients with cSDH, 14 568 underwent surgical evacuation and 711 underwent surgical evacuation with MMAE. Patients who underwent surgical evacuation alone had higher odds of unplanned readmission, need for repeat surgery, and mortality at 6 months, both before and after propensity score matched analysis.

CONCLUSION

Patients undergoing MMAE with surgical evacuation for cSDH had reduced mortality along with reduced rates of readmission and reoperation, suggesting MMAE as a valuable adjunct in managing cSDH.

Adjunct Middle Meningeal Artery Embolization Versus Surgery for Chronic Subdural Hematoma: A Systematic Review and Meta-Analysis

BACKGROUND

The procedure of middle meningeal artery embolization (MMAE) has emerged as a minimally invasive therapy for chronic subdural hematoma (CSDH). Previous studies comparing MMAE with conventional treatment for CSDH did not differentiate primary/upfront, adjunct, or rescue MMAE, and included both conservative and surgical treatment in the comparison group. We conducted a systematic review and meta-analysis to compare outcomes after adjunct MMAE (MMAE combined with surgical evacuation) versus surgery alone for CSDH.

METHODS

PubMed, Embase, Cochrane, Web of Science, and Scopus databases were searched to August 2023. Primary outcomes were treatment failure and reoperation. Secondary outcomes were complications, mortality, length of hospital stay, 30-day readmission, and follow-up modified Rankin Scale (mRS) > 2. Additional data from our institution was included.

RESULTS

12 published studies and our data yielded 57,165 patients, of whom 1,065 (1.9%) received adjunct MMAE and 56,100 (98.1%) surgery alone. Compared to surgery alone, adjunct MMAE was associated with lower rates of treatment failure (OR = 0.43 [0.23-0.83], p = 0.01), reoperation (OR = 0.45 [0.22-0.90], p = 0.02), and 30-day readmission (OR = 0.50 [0.34-0.73], p < 0.001). Length of hospital stay (MD = 2.49 [-0.51, 5.49], p = 0.10) was non-significantly longer in the adjunct MMAE group. Both groups had comparable rates of treatment-related complications (OR = 0.89 [0.52-1.53], p = 0.67), mortality (OR = 1.05 [0.75-1.46], p = 0.78), and follow-up mRS > 2 (OR = 0.91 [0.39-2.12], p = 0.83).

CONCLUSIONS

Adjunct MMAE reduces treatment failure, reoperation, and readmission rates without increasing morbidity and mortality. MMAE may be considered as an adjunct to surgical evacuation to reduce CSDH recurrence. Randomized trials will further establish the evidence for adjunct MMAE and its role in the management of CSDH.

Craniotomies at an overseas military treatment facility: Maintaining readiness for the unit and the surgeon

INTRODUCTION

Craniotomy and craniectomy are common neurosurgical procedures with wide applications in both civilian and military practice. Skill maintenance for these procedures is required for military providers in the event they are called to support forward deployed service members suffering from combat and non-combat injuries. The presents investigation details the performance of such procedures at a small, overseas military treatment facility (MTF).

MATERIALS AND METHODS

A retrospective review of craniotomy procedures performed at an overseas military treatment facility (MTF) over a 2-year period (2019-2021) was performed. Patient and procedural data were collected for all elective and emergent craniotomies including surgical indications, outcomes, complications, military rank, and impact on duty status and tour curtailment.

RESULTS

A total of 11 patients underwent a craniotomy or craniectomy procedure with an average follow-up of 496.8 days (range 103-797). Seven of the 11 patients were able to undergo surgery, recovery, and convalesce without transfer to a larger hospital network or MTF. Of the 6 patients that were active duty (AD), one returned to full duty while three separated and two remain in partial duty status at latest follow-up. There were four complications in four patients with one death.

CONCLUSIONS

In this series, we demonstrate that cranial neurosurgical procedures can be performed safely and effectively while at an overseas MTF. There are potential benefits to the AD service members, their unit, and family as well as to the hospital treatment team and surgeon as this represents a clinical capability requisite to maintain trauma readiness for future conflicts.

Nationwide Readmission Rates and Hospital Charges for Patients With Surgical Evacuation of Nontraumatic Subdural Hematomas: Part 2-Burr Hole Craniostomy

BACKGROUND

Nontraumatic subdural hematoma (SDH) is a common neurological disease that causes extensive morbidity and mortality. Craniotomy or burr hole craniostomy (BHC) is indicated for symptomatic lesions, but both are associated with high recurrence rates. Although extensive research exists on postoperative complications after BHCs, few studies have examined the underlying causes and predictors of unplanned 30-day hospital readmissions at the national level.

OBJECTIVE

To compare causes for hospital readmission within 30 days after surgical SDH evacuation with BHC and evaluate readmission rates and independent predictors of readmission.

METHODS

This retrospective cohort observational study was designed using the Nationwide Readmissions Database. We identified patients who had undergone BHC for SDH evacuation (2010-2015). National estimates and variances within the cohort were calculated after stratifying, hospital clustering, and weighting variables.

RESULTS

We analyzed 2753 patients who had BHC for SDH evacuation: 675 (24.5%) had at least one 30-day readmission. Annual readmission rates did not vary across the study period ( P = .60). The most common cause of readmission was recurrent SDH (n = 630, 93.3%), and the next most common was postoperative infection (n = 12, 1.8%). Comorbidities significantly associated with readmission included fluid and electrolyte disorders, chronic blood loss anemia, chronic obstructive pulmonary disease, depression, liver disease, and psychosis ( P ≤ .04), but statistically significant independent predictors for readmission included only chronic obstructive pulmonary disease and fluid and electrolyte disorders ( P ≤ .007).

CONCLUSION

These national trends in 30-day readmission rates after nontraumatic SDH evacuation by BHC not otherwise published provide quality benchmarks that can aid national quality improvement efforts.