Abstract
INTRODUCTION Unplanned readmissions are detrimental to patients and are linked to financial penalties for hospitals. The nationwide burden of readmissions following treatment of brain arteriovenous malformation (BAVM) has not been previously described. METHODS The Nationwide Readmissions Database (2010-2014) was queried using ICD-9 codes to identify patients ≥18 years with a primary diagnosis of BAVM who underwent open microsurgical treatment. Causes of readmission and associated outcomes were identified. Exposure variables included demographics, comorbidities, and peri-operative complications. Multivariable analysis was conducted to identify risk factors independently associated with readmission. RESULTS In 3,528 treated with microsurgery, the rate of 30-day and 90-day readmission was 6.0% and 8.2%, respectively. BAVM-associated readmission, while rare, was for seizure (2.8%), intracerebral hemorrhage (1.1%), wound-related complication (1.1%), or hydrocephalus (0.3%). In multivariable analysis, risk factors independently associated readmission include age ≥75th percentile (60+ years vs. younger, OR: 1.6, 95% CI: 1.1-2.5), Elixhauser comorbidity score (OR: 1.3, 95% CI: 1.1-1.4, per additional point), and hydrocephalus (OR: 2.4, 95% CI: 1.2-4.9). AVM hemorrhage before surgery was associated with decreased likelihood of readmission (OR: 0.5, 95% CI: 0.3-0.9). However, AVM hemorrhage was associated with high rate of non-routine discharge disposition (39% vs. 18%, P < .001). Readmission rates were not influenced by gender, insurance status, or discharge disposition. CONCLUSION Readmission following microsurgery for BAVM occur less frequently than that of other cranial neurosurgical procedures. Readmissions are rarely due to the surgical procedure itself and are driven by older age and pre-existing comorbidities. The design of a clinical trial to further demonstrate the safety and efficacy of microsurgery for BAVM is warranted.