The Predictive Value of the HOSPITAL Score and LACE Index for an Adult Neurosurgical Population: A Prospective Analysis

Abstract Objective The HOSPITAL score (HS) and LACE index (LI) are two validated methods for quantifying the risk of 30-day unplanned readmission after discharge. However, neither score has been validated in the neurosurgical population. This study evaluated the HS and LI in the neurosurgical population as effective predictors for 30-day unplanned readmission. Methods We performed a prospective, cohort analysis of all consecutive adult patients admitted to the neurosurgical service between 10/1/2018 and 5/1/2019. Patient medical records were used to calculate HS and LI. HS defined groups as: low risk (0-4), intermediate (5-6), and high (7-12); LI defined risk as low (1-4), moderate (5-9), and high (10-19). Data analysis utilized univariate and multivariate logistic regressions. Results The 1,242 patients included 626 (50.4%) females. Average age was 57.9 years, and the majority of patients (86.5%) underwent surgery during their admission. In multivariate logistic regression, intermediate-risk HS was not predictive of 30-day readmission (OR 1.04, 95% CI 0.57-1.88, P=0.53), whereas high-risk HS did predict readmission (OR 2.87, 95% CI 1.49-5.54, P=0.002). Likewise, moderate-risk LI was not predictive of 30-day unplanned readmission or mortality (OR 1.59, 95% CI 0.88-2.85, P=0.12); however, high-risk LI did predict unplanned readmission or mortality (OR 2.58, 95% CI 1.16-5.73, P=0.02). Both HS and LI demonstrated poor to moderate discrimination (c=0.62 and 0.60, respectively). Conclusion A high-risk HS and high-risk LI were predictive of 30-day unplanned readmission. While neither score is ideal for predicting moderate-risk for 30-day unplanned readmission in neurosurgical patients, both have some predictiveness that may be clinically valuable.