Increased Hospital Surgical Resection Volume Decreases the Rate of 30- and 90-Day Readmission after Acoustic Neuroma Surgery

Background Hospital readmissions constitute a large share of the healthcare financial burden in the United States. A collaborative effort is underway to reduce preventable hospital readmissions due to significant financial incentive introduced by the Affordable Care Act (ACA). The association between patient, hospital, and payer factors with the national rate of readmission has not been previously studied in acoustic neuroma surgery.

Methods All adult inpatients undergoing microsurgical resection for acoustic neuroma in the newly introduced Nationwide Readmissions Database from 2013 to 2014 were included. Readmissions for any cause with a primary diagnosis of neurologic, surgical, or systemic complication within 30- and 90-days after undergoing acoustic neuroma surgery were identified. Multivariable models were used to identify patient, hospital, and administrative factors associated with readmission. Hospital volume was quantified as the number of cases per year.

Results Patients representing a weighted estimate of 4,890 admissions for acoustic neuroma surgery in 2013 to 2014, with 355 thirty-day (7.7%) and 341 ninety-day (9.1%) readmissions were identified. After controlling for patient, hospital, and payer factors, procedural volume was significantly associated with 30-day readmission rate (OR: 0.992, p = 0.03), and 90-day readmission rate (OR: 0.994, p = 0.047). The most common diagnoses during readmission in both 30- and 90-day groups included general central nervous system (CNS) complications/deficits, hydrocephalus, infection, and cerebrospinal fluid (CSF) leakage (rhinorrhea/otorrhea).

Conclusion Increased procedural volume is associated with decreased 30- and 90-day readmission rate for acoustic neuroma surgery after controlling for patient, hospital, and payer factors. Common readmission diagnoses included CNS deficits, hydrocephalus, infection, and CSF leakage. Given the financial incentive by the ACA to reduce hospital readmissions, future studies should seek to further evaluate the role of procedural volume, experience, and expertise.