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Dr. Connolly Takes Aim At Reducing Readmissions After Surgery

Dr.E. Sander Connolly

The neurosurgeons at Columbia University Medical Center are always looking for ways to improve medical and surgical care. Of course, this ongoing quest for better healthcare does not end once surgery is finished!

In all types of surgery, a small number of patients end up being readmitted to the hospital. Sometimes these readmissions are planned, such as when a surgery is scheduled to be done in stages. Sometimes they are unplanned—the result of some kind of complication.

Researchers at Columbia’s Cerebrovascular Research Laboratory, under the direction of Dr. E. Sander Connolly, are working to find out why patients are sometimes readmitted to the hospital after neurosurgery, and what can be done to prevent unplanned readmissions.

Medical student Blake Taylor took the lead on this study, working with senior author Dr. Connolly along with residents Dr. Brett E. Youngerman and Dr. Hannah Goldstein. (See full list of authors below.) Together they have completed the first large-scale study on unplanned neurosurgical readmissions, and it has been accepted for publication in the Journal of Neurosurgery.

The research team used a database of patients in the state of New York to identify all of the patients who had craniotomies (brain surgery) in the last three years. This database contains all admissions and discharges in the state and assigns each patient a code so that the doctors can follow a patient’s care while maintaining patient privacy.

The researchers were then able to find which patients had been readmitted, and why, and how long after surgery the readmission happened. They found that many of the complications that lead to unplanned readmission are preventable, and they tend to happen at predictable times after surgery.

Infection accounted for nearly a third of unplanned readmissions. Medical complications were the second most likely cause of readmission, at a rate of nearly 20 percent. Both of these complications were most likely to occur later in the recovery period, closer to 30 days after surgery. Strokes and seizures happened less frequently, but when they did they tended to happen earlier in the recovery period.

Armed with this data, Dr. Connolly plans to make models that could help doctors identify which patients might need extra care after surgery, and allow them to target interventions for just the right time to prevent potential problems from happening.

For example, since the team found that infection is the cause of most unplanned readmissions, Dr. Connolly and his team have already designed a new study aimed at ways to reduce infection. This new study will test whether putting the antibiotic vancomycin directly on the surgical site will work better to prevent infection than giving a patient antibiotics by mouth or through an IV.

Learn more about Dr. Connolly at his bio page here.

Learn more about the exciting work being done in the Cerebrovascular Research Laboratory here.

Full list of authors for this study “Timing of Complications and Unplanned Readmission after Spinal Procedures in High-Volume Medical Centers in New York State”: Blake E. S. Taylor, B.A., Brett E. Youngerman, M.D., Hannah Goldstein, M.D., Daniel H. Kabat, M.S., Geoffrey Appelboom, M.D., Ph.D., William E. Gold, Ph.D., E. Sander Connolly, Jr., M.D., F.A.C.S.

patient journey

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