389 Advanced Intraoperative Navigated Ultrasound in Brain Tumor Surgery Lessons Learnt from a Personal Experience of 300 Cases

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 293-293
Author(s):  
Aliasgar V Moiyadi
Keyword(s):  
Brain Tumor ◽  
Malignant Gliomas ◽  
Tumor Resection ◽  
3D Ultrasound ◽  
Small Subset ◽  
Neurosurgical Procedures ◽  
Tumor Surgery ◽  
Brain Tumor Surgery ◽  
Resection Control ◽  
Tumor Residue

Abstract INTRODUCTION Navigated 3D-ultrasound (nUS) is a powerful and multi-purpose adjunct during tumor resections. We review our cumulative results in a dedicated neuro-oncology service spanning a six year period, highlighting its role in glioma surgery. METHODS Since 2011 we have been used a navigated 3D ultrasound system for intraoperative image guidance during brain tumor surgery in 300 cases. A prospectively updated database was queried to retrieve demographic, clinico-radiological and pathological details. Specifically, we evaluated the utility of the IOUS in different setups and assessed its predictive accuracy and impact on extent of resection (EOR) as well as survival in gliomas. RESULTS >300 (204 males/96 females) brain tumors were operated [197 high grade gliomas, 28 LGG, 24 Meningiomas, and 51 other tumors]. Radical resection/debulking was intended in 270 (90%). In 30 (10%), only frameless biopsy was performed. The US was intended for resection control in 219 (73%) tumors, most of them being intrinsic gliomas. Intermediate scans prompted further resection in 101 cases (46%). A final resection control scan was performed in 176 cases (confirming complete excision in 99, and residual tumor which could not be further resected in 77). The nUS was a very useful tool in tumor surgery, providing a good diagnostic accuracy (85-90%) in predicting tumor residue. It also helped us improve the EOR in malignant gliomas as well as non-enhancing gliomas. In the subset of resectable tumors, the gross total resection rate was 88%. Further, in a small subset of malignant gliomas, we demonstrated that it helps extend tumor resection beyond the contrast enhancement zone. In GBMs, in a multivariate model, use of the nUS was an independent predictor of survival. CONCLUSION Considering the ease of use, widespread accessibility and low-cost nature, IOUS can be a potentially useful adjunct during a range of neurosurgical procedures, especially tumor resections.

scholarly journals An intraoperative motor tract positioning method in brain tumor surgery: technical note

2018 ◽  
Vol 129 (3) ◽  
pp. 576-582 ◽  
Author(s):  
Fumio Yamaguchi ◽  
Hirotomo Ten ◽  
Tadashi Higuchi ◽  
Tomoko Omura ◽  
Toyoyuki Kojima ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Brain Mapping ◽  
Motor Evoked Potentials ◽  
Tumor Resection ◽  
Safety Margin ◽  
Mapping Method ◽  
Tumor Surgery ◽  
Brain Tumor Surgery ◽  
Positioning Method ◽  
Motor Tracts

Intraoperative 3D recognition of the motor tract is indispensable to avoiding neural fiber injury in brain tumor surgery. However, precise localization of the tracts is sometimes difficult with conventional mapping methods. Thus, the authors developed a novel brain mapping method that enables the 3D recognition of the motor tract for intrinsic brain tumor surgeries. This technique was performed in 40 consecutive patients with gliomas adjacent to motor tracts that have a risk of intraoperative pyramidal tract damage. Motor tracts were electrically stimulated and identified by a handheld brain-mapping probe, the NY Tract Finder (NYTF). Sixteen-gauge plastic tubes were mounted onto the NYTF and inserted in the estimated direction of the motor tract with reference to navigational information. Only the NYTF was removed, leaving the plastic tubes in their places, immediately after muscle motor evoked potentials were recorded at the minimum stimulation current. Motor tracts were electrically identified in all cases. Three-dimensional information on the position of motor tracts was given by plastic tubes that were neurophysiologically placed. Tips of tubes showed the resection limit during tumor removal. Safe tumor resection with an arbitrary safety margin can be performed by adjusting the length of the plastic tubes. The motor tract positioning method enabled the 3D recognition of the motor tract by surgeons and provided for safe resection of tumors. Tumor resections were performed safely before damaging motor tracts, without any postoperative neurological deterioration.

scholarly journals New Hope in Brain Glioma Surgery: The Role of Intraoperative Ultrasound. A Review

2018 ◽  
Vol 8 (11) ◽  
pp. 202 ◽  
Author(s):  
Maria Pino ◽  
Alessia Imperato ◽  
Irene Musca ◽  
Rosario Maugeri ◽  
Giuseppe Giammalva ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Brain Tumors ◽  
Low Cost ◽  
Tumor Resection ◽  
Intraoperative Ultrasound ◽  
Tumor Surgery ◽  
Brain Tumor Surgery ◽  
Glioma Surgery ◽  
Pubmed Database

Maximal safe resection represents the gold standard for surgery of malignant brain tumors. As regards gross-total resection, accurate localization and precise delineation of the tumor margins are required. Intraoperative diagnostic imaging (Intra-Operative Magnetic Resonance-IOMR, Intra-Operative Computed Tomography-IOCT, Intra-Operative Ultrasound-IOUS) and dyes (fluorescence) have become relevant in brain tumor surgery, allowing for a more radical and safer tumor resection. IOUS guidance for brain tumor surgery is accurate in distinguishing tumor from normal parenchyma, and it allows a real-time intraoperative visualization. We aim to evaluate the role of IOUS in gliomas surgery and to outline specific strategies to maximize its efficacy. We performed a literature research through the Pubmed database by selecting each article which was focused on the use of IOUS in brain tumor surgery, and in particular in glioma surgery, published in the last 15 years (from 2003 to 2018). We selected 39 papers concerning the use of IOUS in brain tumor surgery, including gliomas. IOUS exerts a notable attraction due to its low cost, minimal interruption of the operational flow, and lack of radiation exposure. Our literature review shows that increasing the use of ultrasound in brain tumors allows more radical resections, thus giving rise to increases in survival.

scholarly journals The Impact of Hospital Safety-Net Burden on Outcomes for Primary Supratentorial Brain Tumor Surgery

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Oliver Young Tang ◽  
Anna Kimata ◽  
Steven A Toms
Keyword(s):  
Brain Tumor ◽  
Length Of Stay ◽  
Severity Of Illness ◽  
Safety Net ◽  
Public Hospitals ◽  
Neurosurgical Procedures ◽  
Tumor Surgery ◽  
Brain Tumor Surgery ◽  
Hospital Safety ◽  
The Impact

Abstract INTRODUCTION Safety-net hospitals treat a disproportionate share of vulnerable patient populations. While outcomes at these institutions for neurosurgical procedures, such as cerebral aneurysm surgery, have been researched, the impact of safety-net burden on brain tumor surgery is poorly characterized. METHODS Using International Classification of Diseases-9 diagnosis codes, we identified all adult admissions in the National Inpatient Sample from 2002 to 2011 undergoing craniotomy for a primary supratentorial brain tumor (191.0-5, 191.8-9, 225.0 and 237.5), excluding patients with brain metastasis (198.3). For each hospital, we quantified safety-net burden as the percentage of patients on Medicaid or without insurance. Hospitals in the top quartile of safety-net burden were categorized as high-burden hospitals (HBHs) while the remainder were low-burden hospitals (LBHs). Survey-weighted multivariate regression was used to make national estimates and adjust for 12 confounding variables: age, sex, insurance, household income, severity of illness and risk of mortality scores, Charlson Comorbidity Index, malignant status, hospital ownership, teaching status, region, and volume. RESULTS We analyzed 162 828 total admissions admitted to 1135 hospitals for brain tumor craniotomy in 2002 to 2011. A total of 212 hospitals (19%) were classified as HBHs, treating 16 914 admissions. HBHs were more likely to be low-volume and public hospitals (both P < .001). Moreover, patients at HBHs were less likely to be white and had higher severity of illness scores (both P < .001). When evaluating outcomes, hospital safety-net status was not associated with mortality (P = .260), favorable discharge disposition (P = .765), or perioperative complications (P = .757). However, admission to HBHs was associated with higher length of stay (+ 0.74 d, P = .007) and inpatient costs (+ $2 448, P = .002). CONCLUSION Although safety-net burden was not associated with mortality, disposition, or complications, patients at safety-net hospitals exhibited increased length of stay and costs, potentially due to factors like resource limitations or more advanced disease presentation among safety-net patients. Amidst potential reforms like “pay-for-performance” reimbursement models, it is critical to further study neurosurgical outcomes at safety-net hospitals.

scholarly journals Safety and Costs Analysis of a Fast-track Algorithm for Early Hospital Discharge After Brain Tumor Surgery

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Danilo Gomes Quadros ◽  
Iuri S Neville ◽  
Francisco M Urena ◽  
Davi J Fontoura Solla ◽  
Wellingson S Paiva ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Hospital Discharge ◽  
Readmission Rate ◽  
Fast Track ◽  
Tumor Resection ◽  
Hospital Costs ◽  
Tumor Surgery ◽  
Brain Tumor Surgery ◽  
Hospitalization Costs ◽  
Brain Tumor Resection

Abstract INTRODUCTION Until the 1990 s, perioperative care was based on empirical concepts and common practice, in part due to the paucity of scientific evidence. With the need of improving patient outcomes and reducing costs, the concern of developing safe and effective standards in postoperative care emerged. Recently, our institution has adopted a daily algorithm for hospital discharge (DAHD), which is a key point in the concept of Fast-Track Surgery. Thus, we designed a study to evaluate whether there was a difference in length of stay (LOS), rate of complications, and hospital costs after the introduction of the DAHD in the postoperative management of patients who underwent brain tumor resection. METHODS This is a retrospective cohort study. All consecutive patients who underwent brain tumor resection in 2017 by a single neurosurgeon were analyzed. Demographic and procedure-related variables, clinical outcomes, and healthcare costs within 30 d after surgery were collected and compared in patients before (preimplementation) and after (postimplementation) the daily algorithm for hospital discharge (DAHD). RESULTS About 61 patients who had been submitted to brain tumor resection were studied (preimplementation 32, postimplementation 29). The baseline demographic characteristics were similar between the groups. After the DAHD implementation, LOS after surgery in days decreased significantly (median 5 vs 3 days; P = .001). The proportion of patients who were discharged within day 1 or 2 after surgery was significantly higher after DAHD protocol (3.1% vs 44.8%; P < .001). Major and minor complications rates, readmission rate, and unplanned return to hospital in 30-day follow-up were comparable between the groups. There was a significant reduction in the median costs of hospitalization in DAHD group (US$2135 vs US$2765, P = .043), mainly due to a reduction in median ward costs (US$922 vs US$1623, P = .009). CONCLUSION Early discharge after brain tumor surgery was safe, inexpensive, reduced the LOS, and hospitalization costs without increase in readmission rate or postoperative complications.

Transcranial Electrical Motor Evoked Potential Monitoring for Brain Tumor Resection

Neurosurgery ◽  
2001 ◽  
Vol 48 (5) ◽  
pp. 1075-1081 ◽  
Author(s):  
Henry H. Zhou ◽  
Patrick J. Kelly
Keyword(s):  
Brain Tumor ◽  
Evoked Potential ◽  
Tumor Resection ◽  
Motor Evoked Potential ◽  
Motor Deficits ◽  
Tumor Surgery ◽  
Brain Tumor Surgery ◽  
Stimulation Intensity ◽  
Potential System ◽  
Brain Tumor Resection

Abstract OBJECTIVE This study was designed to examine whether transcranial electrical motor evoked potential (MEP) monitoring is safe, feasible, and valuable for brain tumor surgery. METHODS Fifty consecutive patients undergoing brain tumor resection were studied, using nitrous oxide/propofol anesthesia. MEPs were continuously recorded throughout surgery, using a Sentinel 4 evoked potential system (Axon Systems, Inc., Hauppauge, NY). The MEPs were elicited by transcranial electrical stimulation (train of 5; stimulation rate, 0.5–2 Hz; square wave pulse with a time constant of 0.5 ms; stimulation intensity, 40–160 mA) through spiral electrodes placed over the primary motor cortex and were recorded by needle electrodes inserted into the contralateral orbicularis oris, biceps, abductor pollicis brevis, and anterior tibialis muscles. When MEP amplitudes decreased by more than 50%, MEP stimulation was repeated, with increased stimulation intensity, and MEP changes were reported to the surgeon. The motor function of each patient was examined before and after surgery, using a reproducible scale. The relationship between MEP amplitude decreases and worsening motor status was analyzed using linear regression. RESULTS Preoperative neurological examinations revealed mild to moderate motor deficits (2/5 to 4/5) for 38% of patients (19 of 50 patients). Most of the patients (96%) exhibited recordable baseline MEPs. Persistent MEP decreases of more than 50% were noted for eight patients (16%) (11 muscles). The MEPs were completely abolished in two patients (three muscles). The degree of postoperative worsening of motor status was correlated with the degree of intraoperative MEP amplitude reduction (r = −0.864; P &lt; 0.001). CONCLUSION Persistent intraoperative MEP reductions of more than 50% were associated with postoperative motor deficits. The degree of MEP amplitude reduction was correlated with postoperative worsening of motor status. Transcranial electrical MEP monitoring is feasible, safe, and valuable for brain tumor surgery.

The utility of intraoperative MRI during pediatric brain tumor surgery: a single-surgeon case series

2019 ◽  
Vol 24 (5) ◽  
pp. 577-583
Author(s):  
Emily L. Day ◽  
R. Michael Scott
Keyword(s):  
Brain Tumor ◽  
Tumor Resection ◽  
Extent Of Resection ◽  
Intraoperative Mri ◽  
Anatomical Location ◽  
Tumor Surgery ◽  
Brain Tumor Surgery ◽  
Intraoperative Complication ◽  
Imaging Characteristics

OBJECTIVEThe authors sought to evaluate the utility of intraoperative MRI (ioMRI) during brain tumor excision in pediatric patients and to suggest guidelines for its future use.METHODSAll patients who underwent brain tumor surgery by the senior author at Boston Children’s Hospital using ioMRI between 2005 and 2009 were included in this retrospective review of hospital records and the neurosurgeon’s operative database. Prior to the review, the authors defined the utility of ioMRI into useful and not useful categories based on how the technology affected operative management. They determined that ioMRI was useful if it 1) effectively guided the extent of resection; 2) provided a baseline postoperative scan during the same anesthesia session; or 3) demonstrated or helped to prevent an intraoperative complication. The authors determined that ioMRI was not useful if 1) the anatomical location of the tumor had precluded a tumor’s total resection, even though the surgeon had employed ioMRI for that purpose; 2) the tumor’s imaging characteristics prevented an accurate assessment of resection during intraoperative imaging; 3) the surgeon deemed the technology not required for tumor resection; or 4) the intraoperative MR images were uninterpretable for technical reasons. Follow-up data provided another gauge of the long-term benefit of ioMRI to the patient.RESULTSA total of 53 brain tumor patients were operated on using ioMRI, 6 of whom had a second ioMRI procedure during the study period. Twenty-six patients were female, and 27 were male. The mean follow-up was 4.8 ± 3.85 years (range 0–12 years). By the criteria outlined above, ioMRI technology was useful in 38 (64.4%) of the 59 cases, most frequently for its help in assessing extent of resection.CONCLUSIONSIntraoperative MRI technology was useful in the majority of brain tumor resections in this series, especially in those tumors that were contrast enhancing and located largely within accessible areas of the brain. The percentage of patients for whom ioMRI is useful could be increased by preoperatively evaluating the tumor’s imaging characteristics to determine if ioMRI would accurately assess the extent of tumor resection, and by the surgeon’s preoperative understanding that use of the ioMRI will not lead to resection of an anatomically unresectable tumor. The ioMRI can prove useful in unresectable tumors if specific operative goals are defined preoperatively.

scholarly journals Safety and Efficacy of Microporous Polysaccharide Hemospheres in Neurosurgery

2011 ◽  
Vol 69 (suppl_1) ◽  
pp. ons49-ons63 ◽  
Author(s):  
Christoph A Tschan ◽  
Meike Nieß ◽  
Eike Schwandt ◽  
Joachim Oertel
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Brain Tumor ◽  
Magnetic Resonance ◽  
Tumor Resection ◽  
Tumor Surgery ◽  
Resonance Imaging ◽  
Brain Tumor Surgery ◽  
Safety And Efficacy ◽  
Computed Tomography Scans

Abstract BACKGROUND: Effective hemostasis is mandatory for brain tumor surgery. Microporous polysaccharide hemosphere (MPH) powder, a white powder compounded from potato starch, was recently introduced for surgical and emergency application. OBJECTIVE: To evaluate the safety and efficacy of MPHs in brain tumor surgery. METHODS: Thirty-three patients (mean age, 58 years; range, 22-84 years) underwent microsurgical brain tumor resection. Final hemostasis was performed by topical application of MPHs, video recorded, and subsequently analyzed. Blood samples were taken before surgery, before application of hemospheres, and postoperatively. Volume measurements of the tumor, resection cavity, and postoperative hematoma were done on magnetic resonance imaging and computed tomography scans. Clinical examinations focused on neurological outcome, complications, and allergic reactions. RESULTS: Effective hemostasis was achieved by exclusive use of MPHs in 32 patients. In 1 patient, a single arterial bleeding underwent additional bipolar electrocauterization. Mean operative time was 156.8 minutes (range, 60-235 minutes). Hemostasis with MPHs required 57 seconds (mean; range, 8-202 seconds). Subjective neurosurgeons' ranking of the hemostasis effect indicated excellent satisfaction. For the first 3 months, there was no hemospheres-related postoperative neurological worsening, no signs of allergic reaction, and no embolic complications. Early postoperative and 3-month follow-up magnetic resonance imaging and computed tomography scans excluded any expansive bleeding complication. As early as postoperative day 1, MPHs were no longer detected. There was no tumor mimicking contrast enhancement. CONCLUSION: In neurosurgery, MPHs allow fast and effective minimally invasive hemostasis. In this small case series, no adverse reactions were found.

scholarly journals Predicting functional impairment in brain tumor surgery: the Big Five and the Milan Complexity Scale

2015 ◽  
Vol 39 (6) ◽  
pp. E14 ◽  
Author(s):  
Paolo Ferroli ◽  
Morgan Broggi ◽  
Silvia Schiavolin ◽  
Francesco Acerbi ◽  
Valentina Bettamio ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Big Five ◽  
Complication Rate ◽  
Tumor Resection ◽  
Case Series ◽  
Karnofsky Performance Scale ◽  
Tumor Surgery ◽  
Brain Tumor Surgery ◽  
Grading Scale ◽  
Clinical Worsening

OBJECT The Milan Complexity Scale—a new practical grading scale designed to estimate the risk of neurological clinical worsening after performing surgery for tumor removal—is presented. METHODS A retrospective study was conducted on all elective consecutive surgical procedures for tumor resection between January 2012 and December 2014 at the Second Division of Neurosurgery at Fondazione IRCCS Istituto Neurologico Carlo Besta of Milan. A prospective database dedicated to reporting complications and all clinical and radiological data was retrospectively reviewed. The Karnofsky Performance Scale (KPS) was used to classify each patient’s health status. Complications were divided into major and minor and recorded based on etiology and required treatment. A logistic regression model was used to identify possible predictors of clinical worsening after surgery in terms of changes between the preoperative and discharge KPS scores. Statistically significant predictors were rated based on their odds ratios in order to build an ad hoc complexity scale. For each patient, a corresponding total score was calculated, and ANOVA was performed to compare the mean total scores between the improved/unchanged and worsened patients. Relative risk (RR) and chi-square statistics were employed to provide the risk of worsening after surgery for each total score. RESULTS The case series was composed of 746 patients (53.2% female; mean age 51.3 ± 17.1). The most common tumors were meningiomas (28.6%) and glioblastomas (24.1%). The mortality rate was 0.94%, the major complication rate was 9.1%, and the minor complication rate was 32.6%. Of 746 patients, 523 (70.1%) patients improved or remained unchanged, and 223 (29.9%) patients worsened. The following factors were found to be statistically significant predictors of the change in KPS scores: tumor size larger than 4 cm, cranial nerve manipulation, major brain vessel manipulation, posterior fossa location, and eloquent area involvement (Nagelkerke R2 = 0.286). A grading scale was obtained with scores ranging between 0 and 8. Worsened patients showed mean total scores that were significantly higher than the improved/unchanged scores (3.24 ± 1.55 vs 1.47 ± 1.58; p < 0.001). Finally, a grid was developed to show the risk of worsening after surgery for each total score: scores higher than 3 are suggestive of worse clinical outcome. CONCLUSIONS Through the evaluation of the 5 aforementioned parameters—the Big Five—the Milan Complexity Scale enables neurosurgeons to estimate the risk of a negative clinical course after brain tumor surgery and share these data with the patient. Furthermore, the Milan Complexity Scale could be used for research and educational purposes and better health system management.

Epilepsy surgery following brain tumor resection in children

2011 ◽  
Vol 7 (3) ◽  
pp. 229-234 ◽  
Author(s):  
Ashley G. Tian ◽  
Michael S. B. Edwards ◽  
Nicole J. Williams ◽  
Donald M. Olson
Keyword(s):  
Brain Tumor ◽  
Epilepsy Surgery ◽  
Tumor Resection ◽  
Choroid Plexus Papilloma ◽  
Intractable Epilepsy ◽  
Residual Tumor ◽  
Dysembryoplastic Neuroepithelial Tumor ◽  
Tumor Surgery ◽  
Brain Tumor Surgery ◽  
Imaging Results

Object Intractable epilepsy following successful brain tumor surgery in children may have several underlying causes such as residual tumor, cortical dysplasia, and gliosis. The authors reviewed the cases of children who had previously undergone resection of a brain tumor only to have medically refractory seizures postoperatively. Methods The authors performed a retrospective case review of 9 children who underwent brain tumor surgery 2–13 years before undergoing a second surgery to try and control their seizures. Results Eight of 9 children had seizures at the time of tumor presentation. Tumor types included ganglioglioma, dysembryoplastic neuroepithelial tumor, pilocytic astrocytoma, oligodendroglioma, ependymoma, and choroid plexus papilloma. All patients achieved a seizure-free interval before intractable seizures recurred. After the second operation, 3 children were seizure free, 1 only had auras, 2 had rare complex partial seizures, and 3 continued to have relatively frequent seizures, although the frequency and severity were reduced. Seven of 9 patients had pathology showing residual tumor. Conclusions Epilepsy surgery following earlier brain tumor surgery can provide substantial benefit with reduced seizure number and severity. Despite reassuring brain imaging results, residual tumor was present more often than expected in pathological specimens.

scholarly journals Unplanned readmissions and survival following brain tumor surgery

2015 ◽  
Vol 122 (1) ◽  
pp. 61-68 ◽  
Author(s):  
Holly Dickinson ◽  
Christine Carico ◽  
Miriam Nuño ◽  
Debraj Mukherjee ◽  
Alicia Ortega ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Patient Outcomes ◽  
Retrospective Review ◽  
Multivariate Analyses ◽  
Tumor Resection ◽  
Tumor Surgery ◽  
Thromboembolic Complications ◽  
Brain Tumor Surgery ◽  
Factors Associated ◽  
Risk Of Mortality

OBJECT Research on readmissions has been influenced by efforts to reduce hospital cost and avoid penalties stipulated by the Centers for Medicare and Medicaid Services. Less emphasis has been placed on understanding these readmissions and their impact on patient outcomes. This study 1) delineates reasons for readmission, 2) explores factors associated with readmissions, and 3) describes their impact on the survival of glioblastoma patients. METHODS The authors conducted a retrospective review of 362 cases involving patients with glioblastoma undergoing biopsy or tumor resection at their institution between 2003 and 2011. Reasons for re-hospitalization were characterized according to whether or not they were related to surgery and considered preventable. Multivariate analyses were conducted to identify the effect of readmission on survival and determine factors associated with re-hospitalizations. RESULTS Twenty-seven (7.5%) of 362 patients experienced unplanned readmissions within 30 days of surgery. Six patients (22.2%) were readmitted by Day 7, 14 (51.9%) by Day 14, and 20 (74.1%) by Day 21. Neurological, infectious, and thromboembolic complications were leading reasons for readmission, accounting for, respectively, 37.0%, 29.6%, and 22.2% of unplanned readmissions. Twenty-one (77.8%) of the 27 readmissions were related to surgery and 19 (70.4%) were preventable. The adjusted hazard ratio of mortality associated with a readmission was 2.03 (95% CI 1.3–3.1). Higher-functioning patients (OR 0.96, 95% CI 0.9–1.0) and patients discharged home (OR 0.21, 95% CI 0.1–0.6) were less likely to get readmitted. CONCLUSIONS An overwhelming fraction of documented unplanned readmissions were considered preventable and related to surgery. Patients who were readmitted to the hospital within 30 days of surgery had twice the risk of mortality compared with patients who were not readmitted.

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