Acta Neurochirurgica

, Volume 161, Issue 6, pp 1057–1065 | Cite as

Establishing risk-adjusted quality indicators in surgery using administrative data—an example from neurosurgery

  • Stephanie SchipmannEmail author
  • Julian Varghese
  • Tobias Brix
  • Michael Schwake
  • Dennis Keurhorst
  • Sebastian Lohmann
  • Eric Suero Molina
  • Uwe Max Mauer
  • Martin Dugas
  • Nils Warneke
  • Walter Stummer
Original Article - Neurosurgery general
Part of the following topical collections:
  1. Neurosurgery general



The current draft of the German Hospital Structure Law requires remuneration to incorporate quality indicators. For neurosurgery, several quality indicators have been discussed, such as 30-day readmission, reoperation, or mortality rates; the rates of infections; or the length of stay. When comparing neurosurgical departments regarding these indicators, very heterogeneous patient spectrums complicate benchmarking due to the lack of risk adjustment.


In this study, we performed an analysis of quality indicators and possible risk adjustment, based only on administrative data.


All adult patients that were treated as inpatients for a brain or spinal tumour at our neurosurgical department between 2013 and 2017 were assessed for the abovementioned quality indicators. DRG-related data such as relative weight, PCCL (patient clinical complexity level), ICD-10 major diagnosis category, secondary diagnoses, age and sex were obtained. The age-adjusted Charlson Comorbidity Index (CCI) was calculated. Logistic regression analyses were performed in order to correlate quality indicators with administrative data.


Overall, 2623 cases were enrolled into the study. Most patients were treated for glioma (n = 1055, 40.2%). The CCI did not correlate with the quality indicators, whereas PCCL showed a positive correlation with 30-day readmission and reoperation, SSI and nosocomial infection rates.


All previously discussed quality indicators are easily derived from administrative data. Administrative data alone might not be sufficient for adequate risk adjustment as they do not reflect the endogenous risk of the patient and are influenced by certain complications during inpatient stay. Appropriate concepts for risk adjustment should be compiled on the basis of prospectively designed registry studies.


Quality indicators Neurosurgery Readmission Reoperation Risk adjustment Administrative data 


Compliance with ethical standard

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the local ethic committee. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all participants included in the study.


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  • Stephanie Schipmann
    • 1
    Email author
  • Julian Varghese
    • 2
  • Tobias Brix
    • 2
  • Michael Schwake
    • 1
  • Dennis Keurhorst
    • 1
  • Sebastian Lohmann
    • 1
  • Eric Suero Molina
    • 1
  • Uwe Max Mauer
    • 3
  • Martin Dugas
    • 2
  • Nils Warneke
    • 1
  • Walter Stummer
    • 1
  1. 1.Department of NeurosurgeryUniversity Hospital MünsterMünsterGermany
  2. 2.Institute of Medical InformaticsUniversity Hospital MünsterMünsterGermany
  3. 3.Department of NeurosurgeryGerman Armed Forces Hospital UlmUlmGermany

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