{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T03:43:13Z","timestamp":1761709393263,"version":"3.40.3"},"reference-count":34,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>Subdural hematoma (SDH) is a common disease that is increasingly being managed nonoperatively. The all-cause readmission rate for SDH has not previously been described. This study seeks to describe the incidence of unexpected 30-day readmission in a cohort of patients admitted to an academic neurosurgical center. Additionally, the relationship between operative management, clinical outcome, and unexpected readmission is explored.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>This is an observational study of 200 consecutive adult patients with SDH admitted to the neurosurgical ICU of an academic medical center. Demographic information, clinical characteristics, and treatment strategies were compared between readmitted and nonreadmitted patients. Multivariable logistic regression, weighted by the inverse probability of receiving surgery using propensity scores, was used to evaluate the association between operative management and unexpected readmission.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Of 200 total patients, 18 (9%) died during hospitalization and were not included in the analysis. Overall, 48 patients (26%) were unexpectedly readmitted within 30 days. Sixteen patients (33.3%) underwent SDH evacuation during their readmission. Factors significantly associated with unexpected readmission were nonoperative management (72.9% vs 54.5%, p = 0.03) and female sex (50.0% vs 32.1%, p = 0.03). In logistic regression analysis weighted by the inverse probability of treatment and including likely confounders, surgical management was not associated with likelihood of a good outcome at hospital discharge, but was associated with significantly reduced odds of unexpected readmission (OR 0.19, 95% CI 0.08\u20130.49).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Over 25% of SDH patients admitted to an academic neurosurgical ICU were unexpectedly readmitted within 30 days. Nonoperative management does not affect outcome at hospital discharge but is significantly associated with readmission, even when accounting for the probability of treatment by propensity score weighted logistic regression. Additional research is needed to validate these results and to further characterize the impact of nonoperative management on long-term costs and clinical outcomes.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2017.6.jns17188","type":"journal-article","created":{"date-parts":[[2017,12,22]],"date-time":"2017-12-22T15:01:37Z","timestamp":1513954897000},"page":"1008-1016","source":"Crossref","is-referenced-by-count":9,"title":["A propensity score analysis of the impact of surgical intervention on unexpected 30-day readmission following admission for subdural hematoma"],"prefix":"10.3171","volume":"129","author":[{"given":"Lynze R.","family":"Franko","sequence":"first","affiliation":[{"name":"University of Michigan Medical School;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyle M.","family":"Sheehan","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"Neurology, University of Michigan, Ann Arbor, Michigan; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher D.","family":"Roark","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Colorado, Denver, Colorado"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacob R.","family":"Joseph","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James F.","family":"Burke","sequence":"additional","affiliation":[{"name":"Neurology, University of Michigan, Ann Arbor, Michigan; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Venkatakrishna","family":"Rajajee","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"Neurology, University of Michigan, Ann Arbor, Michigan; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Craig A.","family":"Williamson","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"Neurology, University of Michigan, Ann Arbor, Michigan; and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Stat Med","doi-asserted-by":"publisher","first-page":"3661","DOI":"10.1002\/sim.6607","article-title":"Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies","volume":"34","author":"Austin PC","year":"2015","unstructured":"Austin PC, Stuart EA: Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies. Stat Med 34:3661\u20133679, 20152623895810.1002\/sim.6607"},{"key":"b2","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1209","DOI":"10.3171\/2014.9.JNS141550","article-title":"Actual and projected incidence rates for chronic subdural hematomas in United States Veterans Administration and civilian populations","volume":"123","author":"Balser D","year":"2015","unstructured":"Balser D, Farooq S, Mehmood T, Reyes M, Samadani U: Actual and projected incidence rates for chronic subdural hematomas in United States Veterans Administration and civilian populations. J Neurosurg 123:1209\u20131215, 201510.3171\/2014.9.JNS14155025794342"},{"issue":"3 Suppl","key":"b3","series-title":"Neurosurgery","first-page":"S16","article-title":"Surgical management of acute subdural hematomas","volume":"58","author":"Bullock MR","unstructured":"Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW, : Surgical management of acute subdural hematomas. Neurosurgery 58 (3 Suppl):S16\u2013S24, Si\u2013Siv, 200616710968"},{"key":"b4","series-title":"Neurology","doi-asserted-by":"publisher","first-page":"2196","DOI":"10.1212\/WNL.0000000000000514","article-title":"Influence of hospital-level practices on readmission after ischemic stroke","volume":"82","author":"Burke JF","year":"2014","unstructured":"Burke JF, Skolarus LE, Adelman EE, Reeves MJ, Brown DL: Influence of hospital-level practices on readmission after ischemic stroke. Neurology 82:2196\u20132204, 20142483879310.1212\/WNL.0000000000000514"},{"key":"b5","series-title":"J Chronic Dis","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: development and validation","volume":"40","author":"Charlson ME","year":"1987","unstructured":"Charlson ME, Pompei P, Ales KL, MacKenzie CR: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373\u2013383, 1987355871610.1016\/0021-9681(87)90171-8"},{"issue":"10 Suppl 2","key":"b6","series-title":"Med Care","doi-asserted-by":"publisher","first-page":"S103","DOI":"10.1097\/MLR.0b013e31806518ac","article-title":"Using inverse probability-weighted estimators in comparative effectiveness analyses with observational databases","volume":"45","author":"Curtis LH","year":"2007","unstructured":"Curtis LH, Hammill BG, Eisenstein EL, Kramer JM, Anstrom KJ: Using inverse probability-weighted estimators in comparative effectiveness analyses with observational databases. Med Care 45 (10 Suppl 2):S103\u2013S107, 200710.1097\/MLR.0b013e31806518ac17909367"},{"key":"b7","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"889","DOI":"10.1016\/j.wneu.2012.06.026","article-title":"Chronic subdural hematoma: a sentinel health event","volume":"80","author":"Dumont TM","year":"2013","unstructured":"Dumont TM, Rughani AI, Goeckes T, Tranmer BI: Chronic subdural hematoma: a sentinel health event. World Neurosurg 80:889\u2013892, 201310.1016\/j.wneu.2012.06.02622722034"},{"key":"b8","series-title":"J Gen Intern Med","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1007\/s11606-014-3106-4","article-title":"Association of early post-discharge follow-up by a primary care physician and 30-day rehospitalization among older adults","volume":"30","author":"Field TS","year":"2015","unstructured":"Field TS, Ogarek J, Garber L, Reed G, Gurwitz JH: Association of early post-discharge follow-up by a primary care physician and 30-day rehospitalization among older adults. J Gen Intern Med 30:565\u2013571, 20152545198710.1007\/s11606-014-3106-4"},{"key":"b9","series-title":"Crit Care Med","doi-asserted-by":"publisher","first-page":"1619","DOI":"10.1097\/CCM.0b013e3182186ed6","article-title":"National trend in prevalence, cost, and discharge disposition after subdural hematoma from 1998-2007","volume":"39","author":"Frontera JA","year":"2011","unstructured":"Frontera JA, Egorova N, Moskowitz AJ: National trend in prevalence, cost, and discharge disposition after subdural hematoma from 1998-2007. Crit Care Med 39:1619\u20131625, 201110.1097\/CCM.0b013e3182186ed621423002"},{"key":"b10","series-title":"Ann Surg","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1097\/SLA.0000000000000912","article-title":"Time-to-readmission and mortality after high-risk surgery","volume":"262","author":"Gonzalez AA","year":"2015","unstructured":"Gonzalez AA, Abdelsattar ZM, Dimick JB, Dev S, Birkmeyer JD, Ghaferi AA: Time-to-readmission and mortality after high-risk surgery. Ann Surg 262:53\u201359, 20152521127410.1097\/SLA.0000000000000912"},{"key":"b11","series-title":"Ann Surg","doi-asserted-by":"publisher","first-page":"659","DOI":"10.1097\/SLA.0b013e3181d3d27c","article-title":"Readmission after colectomy for cancer predicts one-year mortality","volume":"251","author":"Greenblatt DY","year":"2010","unstructured":"Greenblatt DY, Weber SM, O\u2019Connor ES, LoConte NK, Liou JI, Smith MA: Readmission after colectomy for cancer predicts one-year mortality. Ann Surg 251:659\u2013669, 201010.1097\/SLA.0b013e3181d3d27c20224370"},{"key":"b12","series-title":"Psychol Methods","doi-asserted-by":"publisher","first-page":"234","DOI":"10.1037\/a0019623","article-title":"Propensity score techniques and the assessment of measured covariate balance to test causal associations in psychological research","volume":"15","author":"Harder VS","year":"2010","unstructured":"Harder VS, Stuart EA, Anthony JC: Propensity score techniques and the assessment of measured covariate balance to test causal associations in psychological research. Psychol Methods 15:234\u2013249, 20102082225010.1037\/a0019623"},{"key":"b13","series-title":"J Biomed Inform","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)\u2014a metadata-driven methodology and workflow process for providing translational research informatics support","volume":"42","author":"Harris PA","year":"2009","unstructured":"Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG: Research electronic data capture (REDCap)\u2014a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42:377\u2013381, 20091892968610.1016\/j.jbi.2008.08.010"},{"key":"b14","series-title":"Neurol Res","doi-asserted-by":"publisher","first-page":"985","DOI":"10.1179\/1743132815Y.0000000083","article-title":"Chronic subdural haematoma associated with disturbance of consciousness: significance of acute-on-chronic subdural haematoma","volume":"37","author":"Honda Y","year":"2015","unstructured":"Honda Y, Sorimachi T, Momose H, Takizawa K, Inokuchi S, Matsumae M: Chronic subdural haematoma associated with disturbance of consciousness: significance of acute-on-chronic subdural haematoma. Neurol Res 37:985\u2013992, 201510.1179\/1743132815Y.000000008326344395"},{"key":"b15","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"1418","DOI":"10.1056\/NEJMsa0803563","article-title":"Rehospitalizations among patients in the Medicare fee-for-service program","volume":"360","author":"Jencks SF","year":"2009","unstructured":"Jencks SF, Williams MV, Coleman EA: Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med 360:1418\u20131428, 20091933972110.1056\/NEJMsa0803563"},{"key":"b16","series-title":"Lancet","doi-asserted-by":"publisher","first-page":"480","DOI":"10.1016\/S0140-6736(75)92830-5","article-title":"Assessment of outcome after severe brain damage: a practical scale","volume":"1","author":"Jennett B","year":"1975","unstructured":"Jennett B, Bond M: Assessment of outcome after severe brain damage: a practical scale. Lancet 1:480\u2013484, 197510.1016\/S0140-6736(75)92830-5"},{"key":"b17","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"546","DOI":"10.3171\/2014.12.JNS142053","article-title":"Outcomes of chronic subdural hematoma drainage in nonagenarians and centenarians: a multicenter study","volume":"124","author":"Lee L","year":"2016","unstructured":"Lee L, Ker J, Ng HY, Munusamy T, King NK, Kumar D, : Outcomes of chronic subdural hematoma drainage in nonagenarians and centenarians: a multicenter study. J Neurosurg 124:546\u2013551, 201610.3171\/2014.12.JNS14205326162032"},{"key":"b18","series-title":"J Gen Intern Med","doi-asserted-by":"publisher","first-page":"1467","DOI":"10.1007\/s11606-012-2116-3","article-title":"Early hospital readmission is a predictor of one-year mortality in community-dwelling older Medicare beneficiaries","volume":"27","author":"Lum HD","year":"2012","unstructured":"Lum HD, Studenski SA, Degenholtz HB, Hardy SE: Early hospital readmission is a predictor of one-year mortality in community-dwelling older Medicare beneficiaries. J Gen Intern Med 27:1467\u20131474, 20122269263410.1007\/s11606-012-2116-3"},{"key":"b19","series-title":"Circulation","doi-asserted-by":"publisher","first-page":"1796","DOI":"10.1161\/CIRCULATIONAHA.114.010270","article-title":"Hospital readmissions reduction program","volume":"131","author":"McIlvennan CK","year":"2015","unstructured":"McIlvennan CK, Eapen ZJ, Allen LA: Hospital readmissions reduction program. Circulation 131:1796\u20131803, 201510.1161\/CIRCULATIONAHA.114.01027025986448"},{"key":"b20","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"72","DOI":"10.3171\/2010.8.JNS10298","article-title":"Chronic subdural hematoma in the elderly: not a benign disease","volume":"114","author":"Miranda LB","year":"2011","unstructured":"Miranda LB, Braxton E, Hobbs J, Quigley MR: Chronic subdural hematoma in the elderly: not a benign disease. J Neurosurg 114:72\u201376, 20112086821510.3171\/2010.8.JNS10298"},{"key":"b21","series-title":"Neurocrit Care","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1007\/s12028-015-0178-x","article-title":"Adverse outcomes after initial non-surgical management of subdural hematoma: a population-based study","volume":"24","author":"Morris NA","year":"2016","unstructured":"Morris NA, Merkler AE, Parker WE, Claassen J, Connolly ES, Sheth KN, : Adverse outcomes after initial non-surgical management of subdural hematoma: a population-based study. Neurocrit Care 24:226\u2013232, 201610.1007\/s12028-015-0178-x26160466"},{"key":"b22","series-title":"Neurooncol Pract","first-page":"33","article-title":"Quality of surgical care and readmission in elderly glioblastoma patients","volume":"1","author":"Nu\u00f1o M","year":"2014","unstructured":"Nu\u00f1o M, Ly D, Mukherjee D, Ortega A, Black KL, Patil CG: Quality of surgical care and readmission in elderly glioblastoma patients. Neurooncol Pract 1:33\u201339, 201426034614"},{"key":"b23","unstructured":"Patient Protection and Affordable Care Act of 2010, Pub Law 111\u2013148, 124 Stat. 127, Sec. 6301 (March 23, 2010) (http:\/\/www.gpo.gov\/fdsys\/pkg\/PLAW-111publ148\/pdf\/PLAW-111publ148.pdf)"},{"key":"b24","series-title":"Orthopedics","doi-asserted-by":"publisher","first-page":"e7","DOI":"10.3928\/01477447-20150105-53","article-title":"Readmission within 30 days of discharge after hip fracture care","volume":"38","author":"Pollock FH","year":"2015","unstructured":"Pollock FH, Bethea A, Samanta D, Modak A, Maurer JP, Chumbe JT: Readmission within 30 days of discharge after hip fracture care. Orthopedics 38:e7\u2013e13, 20152561142410.3928\/01477447-20150105-53"},{"key":"b25","series-title":"Epidemiology","doi-asserted-by":"publisher","first-page":"550","DOI":"10.1097\/00001648-200009000-00011","article-title":"Marginal structural models and causal inference in epidemiology","volume":"11","author":"Robins JM","year":"2000","unstructured":"Robins JM, Hern\u00e1n MA, Brumback B: Marginal structural models and causal inference in epidemiology. Epidemiology 11:550\u2013560, 200010.1097\/00001648-200009000-0001110955408"},{"key":"b26","series-title":"Med Care","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1097\/MLR.0000000000000455","article-title":"Does use of a hospital-wide readmission measure versus condition-specific readmission measures make a difference for hospital profiling and payment penalties?","volume":"54","author":"Rosen AK","year":"2016","unstructured":"Rosen AK, Chen Q, Shwartz M, Pilver C, Mull HJ, Itani KFM, : Does use of a hospital-wide readmission measure versus condition-specific readmission measures make a difference for hospital profiling and payment penalties? Med Care 54:155\u2013161, 201610.1097\/MLR.000000000000045526595224"},{"key":"b27","series-title":"Biometrika","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1093\/biomet\/70.1.41","article-title":"The central role of the propensity score in observational studies for causal effects","volume":"70","author":"Rosenbaum PR","year":"1983","unstructured":"Rosenbaum PR, Rubin DB: The central role of the propensity score in observational studies for causal effects. Biometrika 70:41\u201355, 198310.1093\/biomet\/70.1.41"},{"article-title":"Medicare Hospital Quality Chartbook. Performance Report on Outcome Measures. September 2014","author":"Schwartz J","key":"b28","unstructured":"Schwartz J, Strait KM, Keshawarz A, Vellanky SS, Reilly EM, Curtis JP, : Medicare Hospital Quality Chartbook. Performance Report on Outcome Measures. September 2014. (https:\/\/www.cms.gov\/medicare\/quality-initiatives-patient-assessment-instruments\/hospitalqualityinits\/downloads\/medicare-hospital-quality-chartbook-2014.pdf) [Accessed August 28, 2017]"},{"key":"b29","series-title":"Arch Intern Med","doi-asserted-by":"publisher","first-page":"1664","DOI":"10.1001\/archinternmed.2010.345","article-title":"Outpatient follow-up visit and 30-day emergency department visit and readmission in patients hospitalized for chronic obstructive pulmonary disease","volume":"170","author":"Sharma G","year":"2010","unstructured":"Sharma G, Kuo YF, Freeman JL, Zhang DD, Goodwin JS: Outpatient follow-up visit and 30-day emergency department visit and readmission in patients hospitalized for chronic obstructive pulmonary disease. Arch Intern Med 170:1664\u20131670, 201010.1001\/archinternmed.2010.34520937926"},{"key":"b30","series-title":"J Clin Epidemiol","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1016\/j.jclinepi.2005.07.004","article-title":"A review of the application of propensity score methods yielded increasing use, advantages in specific settings, but not substantially different estimates compared with conventional multivariable methods","volume":"59","author":"St\u00fcrmer T","year":"2006","unstructured":"St\u00fcrmer T, Joshi M, Glynn RJ, Avorn J, Rothman KJ, Schneeweiss S: A review of the application of propensity score methods yielded increasing use, advantages in specific settings, but not substantially different estimates compared with conventional multivariable methods. J Clin Epidemiol 59:437\u2013447, 200610.1016\/j.jclinepi.2005.07.004"},{"key":"b31","series-title":"Am Heart J","doi-asserted-by":"publisher","first-page":"452","DOI":"10.1067\/mhj.2003.3","article-title":"Comparison of analytic approaches for the economic evaluation of new technologies alongside multicenter clinical trials","volume":"145","author":"Taira DA","year":"2003","unstructured":"Taira DA, Seto TB, Siegrist R, Cosgrove R, Berezin R, Cohen DJ: Comparison of analytic approaches for the economic evaluation of new technologies alongside multicenter clinical trials. Am Heart J 145:452\u2013458, 20031266066810.1067\/mhj.2003.3"},{"key":"b32","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1007\/BF01405862","article-title":"Assessment and prognosis of coma after head injury","volume":"34","author":"Teasdale G","year":"1976","unstructured":"Teasdale G, Jennett B: Assessment and prognosis of coma after head injury. Acta Neurochir (Wien) 34:45\u201355, 197610.1007\/BF01405862"},{"key":"b33","series-title":"Int J Epidemiol","doi-asserted-by":"publisher","first-page":"776","DOI":"10.1093\/ije\/31.4.776","article-title":"Population ageing in the United States of America: implications for public programmes","volume":"31","author":"Wiener JM","year":"2002","unstructured":"Wiener JM, Tilly J: Population ageing in the United States of America: implications for public programmes. Int J Epidemiol 31:776\u2013781, 20021217701810.1093\/ije\/31.4.776"},{"key":"b34","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1007\/BF02307412","article-title":"Criteria for conservative treatment of supratentorial acute subdural haematomas","volume":"135","author":"Wong CW","year":"1995","unstructured":"Wong CW: Criteria for conservative treatment of supratentorial acute subdural haematomas. Acta Neurochir (Wien) 135:38\u201343, 199510.1007\/BF02307412"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/129\/4\/article-p1008.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/129\/4\/article-p1008.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/129\/4\/article-p1008.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,31]],"date-time":"2025-03-31T03:09:59Z","timestamp":1743390599000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/129\/4\/article-p1008.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,10]]},"references-count":34,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/2017.6.jns17188","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"type":"print","value":"0022-3085"},{"type":"electronic","value":"1933-0693"}],"subject":[],"published":{"date-parts":[[2018,10]]}}}