Die ungeplante und frühzeitige Krankenhauswiederaufnahme von Glioblastompatient:innen: Auswirkungen auf die Behandlungsqualität und Behandlungskosten

Unplanned early hospital readmission (UER) was shown to be significantly associated with shortened survival, including patients suffering from glioblastoma (GBM). Moreover, international data proved UER to cause significant economic burden for healthcare systems. Several nations have hence implemented reforms to reduce UER rates, including financial penalties for hospitals with UER rates above average.

For Germany, there is no comprehensive data available concerning the economic role of UER. We therefore analyzed the GBM cohort of a neurosurgical university center with focus on quality of care (QoC) and treatment cost when UER occurred.

All patients with newly diagnosed GBM between 2014 and 2020 were included. Exclusion criteria were age below 18 years and proof of IDH mutation. Clinical patient data as well as data concerning the diagnosis related group (DRG) were retrospectively assessed. UER was defined as unappointed hospital readmission within 30 days after discharge for primary treatment. Statistical analysis was carried our using SPSS.

275 patients newly diagnosed with GBM were included. UER occurred in 37 cases (13,5% of the entire cohort). Most frequent causes for UER were neurological deterioration, post-operative infections and epileptic seizures. Four cases were identified as avoidable hospital readmission.

Concerning QoC of primary treatment, there were no significant differences between sub-cohorts with or without UER. Especially type of surgery, extent of resection, occurrence of post-operative complications or type of adjuvant therapy were equally distributed among sub-cohorts.

For secondary treatment, surgery was necessary in 9 of 37 cases (24,3%), most commonly for surgical site infection or hydrocephalus. Surgical cases were associated with significantly increased treatment costs (average rate per case 7906±7368€ [conservative] vs 19372±12561€ [surgical]; p=0,01) and prolonged length of stay. A comparative analysis between sub-cohorts with and without UER revealed additional costs of averagely 8.737±8.273€ per case and additional 19,9±19,3 days of hospital stay (both p<0.001) for patients with UER.

QoC was similar for patients with or without UER but hospital readmissions were significantly associated with additional treatment costs and in-patient hospital stay. Due to the malignant nature of glioblastoma, UER is partially avoidable in these patients.