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Original research
Continuity of care and 30-day readmission for patients evaluated in the emergency room after cerebral aneurysm treatment
  1. Kimon Bekelis1,2,3,
  2. Symeon Missios4,
  3. Todd A MacKenzie2,3,5,6
  1. 1Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
  2. 2Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
  3. 3The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA
  4. 4Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
  5. 5Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
  6. 6Department of Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
  1. Correspondence to Dr Kimon Bekelis, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA; kbekelis{at}


Background The association between continuity of care and the rate of 30-day readmissions after surgical procedures continues to be debated.

Objective To investigate the association of 30-day readmissions with evaluation in the hospital where the original procedure was performed for patients presenting to the emergency department (ED) after cerebral aneurysm treatment.

Methods We performed a cohort study of patients with cerebral aneurysms, who were evaluated in the ED within 30 days after discharge following surgical clipping or endovascular coiling between 2009 and 2013, and were registered in the Statewide Planning and Research Cooperative System database. A propensity score adjusted model was used to control for confounding, whereas mixed effects accounted for clustering at the hospital level.

Results Of the 452 patients presenting to the ED, 218 (48.2%) were evaluated in a different hospital from that in which the original procedure was performed (7.7% readmitted), and 234 (51.8%) were evaluated at the original hospital (18.4% readmitted). In a multivariable analysis, we showed that evaluation in the ED of the original hospital was associated with decreased rate of 30-day readmission (OR=0.41; 95% CI 0.22 to 0.78). We found similar associations in a mixed-effects logistic regression model (OR=0.46; 95% CI 0.35 to 0.84) and a propensity score adjusted model (OR=0.41; 95% CI 0.22 to 0.77). This corresponds to10 patients needing to be evaluated in the hospital at which the original procedure was performed to prevent one readmission.

Conclusions Using a comprehensive all-payer cohort of patients in New York State, who were evaluated in the ED after cerebral aneurysm treatment, we identified an association between assessment in the hospital at which the original procedure was performed and a lower rate of 30-day readmissions. This underlines the potential importance of continuity of care for surgical patients to prevent readmission.

  • Aneurysm

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  • Contributors KB: concept, design, manuscript preparation, statistical analysis, data interpretation. SM: data interpretation, critical review of manuscript. TAM: data interpretation, statistical analysis, critical review of manuscript.

  • Funding Supported by grants from the National Center for Advancing Translational Sciences (NCATS) of the NIH (Dartmouth Clinical and Translational Science Institute-UL1TR001086). The funders had no role in the design, execution, or interpretation of the study, or the manuscript preparation

  • Competing interests None declared.

  • Ethics approval Centre for Population Health Sciences.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data are included in the study.