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Analysis of intra-operative variables as predictors of 30-day readmission in patients undergoing glioma surgery at a single center

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Abstract

Purpose

Reducing the time from surgery to adjuvant chemoradiation, by decreasing unnecessary readmissions, is paramount for patients undergoing glioma surgery. The effects of intraoperative risk factors on 30-day readmission rates for such patients is currently unclear. We utilized a predictive model-driven approach to assess the impact of intraoperative factors on 30-day readmission rates for the cranial glioma patient.

Methods

Retrospectively, the intraoperative records of 290 patients who underwent glioma surgery at a single institution by a single surgeon were assessed. Data on operative variables including anesthesia specific factors were analyzed via univariate and stepwise regression analysis for impact on 30-day readmission rates. A predictive model was built to assess the capability of these results to predict readmission and validated using leave-one-out cross-validation.

Results

In multivariate analysis, end case hypothermia (OR 0.28, 95% CI [0.09, 0.84]), hypertensive time > 15 min (OR 2.85, 95% CI [1.21, 6.75]), and pre-operative Karnofsky performance status (KPS) (OR 0.63, 95% CI [0.41, 0.98] were identified as being significantly associated with 30-day readmission rates (chi-squared statistic vs. constant model 25.2, p < 0.001). Cross validation of the model resulted in an overall accuracy of 89.7%, a specificity of 99.6%, and area under the receiver operator curve (AUC) of 0.763.

Conclusion

Intraoperative risk factors may help risk-stratify patients with a high degree of accuracy and improve postoperative patient follow-up. Attention should be paid to duration of hypertension and end-case final temperature as these represent potentially modifiable factors that appear to be highly associated with 30-day readmission rates. Prospective validation of our model is needed to assess its potential for implementation as a screening tool to identify patients undergoing glioma surgery who are at a higher risk of post-operative readmission within 30 days

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Funding

No funding was received for the execution of this study.

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Authors and Affiliations

  1. Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, 33136, USA

    Iahn Cajigas, Anil K. Mahavadi, Ashish H. Shah, Veronica Borowy, Michael E. Ivan & Ricardo J. Komotar

  2. Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL, USA

    Nathalie Abitbol & Richard H. Epstein

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  1. Iahn Cajigas
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Correspondence to Iahn Cajigas.

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Cajigas, I., Mahavadi, A.K., Shah, A.H. et al. Analysis of intra-operative variables as predictors of 30-day readmission in patients undergoing glioma surgery at a single center. J Neurooncol 145, 509–518 (2019). https://doi.org/10.1007/s11060-019-03317-6

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