Factors affecting readmission following craniotomy for tumor resection in children and young adults

Introduction: : Readmission rate is often employed as a surrogate marker for quality of care, readmission rates may incur financial penalties for hospitals. Thus, investigation is merited, especially in fields like neurosurgery, in which procedures are accompanied by both high risk and high cost. While numerous studies have investigated readmission of adult patients undergoing craniotomy for tumor, none have done so for pediatric patients. The authors aim to address the paucity of data on craniotomy for pediatric brain tumors, to elucidate the predictive and causative factors of readmission, and to guide continuing improvements in both quality and value of care.

Methods: A retrospective chart review was performed of all craniotomies performed for tumor resection at the tertiary care children’s hospital from Jan 1, 2010 to Dec 31, 2019. Primary outcome measures included rates of unplanned 90-day readmission. Secondary outcome measures included factors associated with readmission, including patient demographics, tumor grade and type, length of stay and postoperative complications.

Results: In total, 159 of 1093 patients (14.5%) were readmitted within 90 days at our institution. Age, (p=.0092), especially age 0-5 years (p=.0099), length of stay (p=0.0223) and high-grade tumors (p=0.015) were identified as predictive of 90 day readmission. Tumor types significantly associated with readmission events were craniopharyngioma (p=0.0250), embryonal type tumors (p=0.0005), high grade gliomas (p=0.0345), and medulloblastoma (p=0.0498). Findings from multivariate analysis showed only LOS (p=0.0152) and high-grade vs low-grade tumor (OR= 1.7732; p=0.0498) as significant predictors of 90 day readmission. Race (p=.4663), sex (p=0.4626), insurance status (p=0.8635), tumor location (p=.6808), or post-op complications (p=0.0863) did not prove to be significant predictors of readmission events.

Conclusion : Length of stay, younger age, and tumor type were identified as significant predictive factors contributing to 90-day readmission rates in pediatric craniotomy for tumor patients.