Sherrod et al identified factors associated with unplanned readmission following pediatric neurosurgery. A patient with one or more of these factors may benefit from more aggressive management. The authors are from the University of Alabama in Birmingham.
Patient selection: pediatric patient after neurosurgery
Outcome: unplanned readmission within 30 days
Procedures with the highest risk of readmission:
(1) CSF shunt creation or revision
(2) repair of a myelomeningocele > 5 cm in diameter
(3) craniectomy for excision of an infratentorial tumor
Risk factors for unplanned readmission with odds ratios from 4.3 to 26:
(1) postoperative surgical site infection (SSI), including wound disruption
(2) postoperative pneumonia
(3) postoperative urinary tract infection (UTI)
(4) graft or prosthesis failure
Risk factors with odds ratios ratios 2.4 to 2.6:
(1) sepsis
(2) Native American race
(3) postoperative seizure
Risk factors with odds ratios less than 2.0 (see Table 8):
(1) corticosteroid use > 10 days
(2) oxygen supplementation
(3) need for nutritional support
(4) pre-existing seizure disorder
(5) long surgical procedure (odds ratio 1.06 per hour; 1.4 after 6 hours)
(6) significant comorbid conditions
(7) home discharge
