{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:14:07Z","timestamp":1782778447628,"version":"3.54.5"},"reference-count":45,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2024,2,6]],"date-time":"2024-02-06T00:00:00Z","timestamp":1707177600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Objective<\/jats:title><jats:p>The purpose of this study was to present the first comprehensive analysis of perioperative quality indicators; length of hospital stay; readmission; reoperation; pre-, intra, and postoperative events; and mortality in a diverse neurosurgical patient cohort in Europe.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methods<\/jats:title><jats:p>Electronic medical records of all patients who were admitted to our institution between January 1 and December 31 of 2020, and underwent an index neurosurgical operation (n = 1142) were retrospectively reviewed.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Results<\/jats:title><jats:p>The median length of hospital stay at the index admission and readmission was 8 days (range: 1\u2013242 days) and 5 days (range: 0\u201394 days), respectively. Of the 1142 patients, 22.9% (n = 262) had an extended length of hospital stay of \u226514 days. The all-cause 7-, 15-, 30-, 60-, and 90-day readmission rates were 3.9% (n = 44), 5.7% (n = 65), 8.8% (n = 100), 12.3% (n = 141), and 16.5% (n = 188), respectively. The main reason for unplanned readmission was deterioration of medical and\/or neurological condition. The all-cause 7-, 15-, 30-, 60-, and 90-day reoperation rates were 11.1% (n = 127), 13.8% (n = 158), 16.5% (n = 189), 18.7% (n = 213), and 19.4% (n = 221), respectively. Unplanned reoperations were due primarily to hydrocephalus. The rate of preoperative events was 1.1% (n = 13), one-third of which were associated with infection. The rate of intraoperative events was 11.0% (n = 126), of which 98 (64.47%) were surgical, 37 (24.34%) were anesthesiologic, and 17 (11.18%) were associated with technical equipment. The rate of postoperative events was 9.5% (n = 109). The most common postoperative event was malfunction, disconnection, or dislocation of an implanted device (n = 24, 17.91%). The mortality rates within 7, 15, 30, 60, and 90 days after the index operation were 0.9% (n = 10), 1.8% (n = 21), 2.5% (n = 29), 3.4% (n = 39), and 4.7% (n = 54), respectively. Several patient characteristics and perioperative factors were significantly associated with outcome parameters.<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Conclusions<\/jats:title><jats:p>This study provides an in-depth analysis of quality indicators in neurosurgery, highlighting a variety of inherent and modifiable factors influencing patient outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0297167","type":"journal-article","created":{"date-parts":[[2024,2,6]],"date-time":"2024-02-06T18:39:29Z","timestamp":1707244769000},"page":"e0297167","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Perioperative quality indicators among neurosurgery patients: A retrospective cohort study of 1142 cases at a tertiary center"],"prefix":"10.1371","volume":"19","author":[{"given":"Edzhem","family":"Chavush","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl","family":"R\u00f6ssler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1843-7732","authenticated-orcid":true,"given":"Christian","family":"Dorfer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,2,6]]},"reference":[{"issue":"26","key":"pone.0297167.ref001","doi-asserted-by":"crossref","first-page":"2477","DOI":"10.1056\/NEJMp1011024","article-title":"What is value in health care?","volume":"363","author":"ME Porter","year":"2010","journal-title":"The New England journal of medicine"},{"issue":"4","key":"pone.0297167.ref002","first-page":"489","article-title":"Is patient length of stay related to quality of care?","volume":"42","author":"JW Thomas","year":"1997","journal-title":"Hospital & health services administration."},{"issue":"12","key":"pone.0297167.ref003","doi-asserted-by":"crossref","first-page":"1134","DOI":"10.1056\/NEJMsa1303118","article-title":"Variation in surgical-readmission rates and quality of hospital care","volume":"369","author":"TC Tsai","year":"2013","journal-title":"The New England journal of medicine"},{"issue":"10","key":"pone.0297167.ref004","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.1097\/00005650-199710000-00006","article-title":"The association between the quality of inpatient care and early readmission: a meta-analysis of the evidence.","volume":"35","author":"CM Ashton","year":"1997","journal-title":"Medical care"},{"issue":"6","key":"pone.0297167.ref005","doi-asserted-by":"crossref","first-page":"665","DOI":"10.3171\/2012.2.PEDS11305","article-title":"Unplanned reoperation rates in pediatric neurosurgery: a single center experience and proposed use as a quality indicator","volume":"9","author":"N Mukerji","year":"2012","journal-title":"Journal of neurosurgery Pediatrics"},{"issue":"1","key":"pone.0297167.ref006","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1007\/s00701-019-04146-2","article-title":"The rise of quality indicators in neurosurgery: 30-day unplanned reoperation rate evaluated in 3760 patients-a single-center experience.","volume":"162","author":"E Suero Molina","year":"2020","journal-title":"Acta neurochirurgica."},{"issue":"2","key":"pone.0297167.ref007","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.nec.2014.11.014","article-title":"Adverse events in neurosurgery and their relationship to quality improvement.","volume":"26","author":"JE Ziewacz","year":"2015","journal-title":"Neurosurgery clinics of North America."},{"issue":"11","key":"pone.0297167.ref008","doi-asserted-by":"crossref","first-page":"e067409","DOI":"10.1136\/bmjopen-2022-067409","article-title":"Mortality as an indicator of quality of neurosurgical care in England: a retrospective cohort study","volume":"12","author":"AJ Wahba","year":"2022","journal-title":"BMJ open"},{"issue":"2","key":"pone.0297167.ref009","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1097\/00000658-199908000-00016","article-title":"Risk factors for prolonged length of stay after major elective surgery","volume":"230","author":"TC Collins","year":"1999","journal-title":"Annals of surgery"},{"issue":"4","key":"pone.0297167.ref010","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1227\/01.NEU.0000175729.79119.1d","article-title":"National trends in surgical procedures for degenerative cervical spine disease: 1990\u20132000.","volume":"57","author":"PG Patil","year":"2005","journal-title":"Neurosurgery"},{"key":"pone.0297167.ref011","unstructured":"OECD. 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