Study Selection
Our initial database search generated 327 reports (Fig. 1)Through abstract and title screening, 319 reports were identified for full-text review. During full-text screening 7 were selected for inclusion and 53 were set aside for author contact prior to making a decision.
Study Characteristics
Table 2 describes the included trials. Many were single- center trials taking place in academic medical centers, enrolling few patients and 30-day readmissions. Most interventions tested took place in both the inpatient and outpatient settings. Most studies were at low risk of bias .The most common methodological limitation of these trials was the lack of a reliable method for dealing with missing data.
Table 1
Demographic characteristics for the included studies
author | year | Country | age | N | Male | Re admission | Re-operation | Most common reason for re-admission |
Aditya Vedantam 22 | 2018 | USA | 10 | 208 | 51.8% | 7.1% | 6.8% | N/A |
Churl-Su Kwon 23 | 2019 | USA | 38.42 ± 1.87 | 2284 | 50.42% | 10.83% | | Seizure |
Paul S. A. Kalanithi 24 | 2013 | USA2005-2009 | 38 | 536 | | 4% | 3.9% | Seizure |
Marissa Vawter-Lee 25 | 2018 | 2014-2016USA | 29.9 ± 1.4 | 1587 | 50.8% | 8% | | Seizure |
Varsha Subramaniam 26 | 2019 | USA | N/A | 2231 | | 12.3% | 12.4% | Seizure |
Nuriel moghavem 6 | 2015 | USA | N/A | 1214 | 53% | 13.9% | N/A | N/A |
Rumalla 10 | 2017 | USA | N/A | 1587 | 50.8% | 11.5% | N/A | seizure |
Table 2
Meta-analysis of the Characteristics of included studies
Characteristics of included studies | 95% conf. interval |
Low | UP | ES | Weight | I2 |
Re admission | 0.093 | 0.105 | 0.099 | 100 | 93.5 |
Re-operation | 0.078 | 0.098 | 0.088 | 100 | 96.7 |
payer | Private | 0.084 | 0.099 | 0.092 | 100 | 99.7 |
Medicaid | 0.041 | 0.052 | 0.047 | 100 | 99.6 |
Medicare | 0.073 | 0.086 | 0.080 | 100 | 99.7 |
complications | Surgical | 0.094 | 0.102 | 0.086 | 100 | 99.5 |
Medical | 0.043 | 0.057 | 0.050 | 100 | 99.2 |
Most common reason for re-admission(seizure) | 0.302 | 0.329 | 0.316 | 100 | 99.6 |
Bed size | Small or medium | 0.045 | 0.056 | 0.051 | 100 | 99.7 |
Large | 0.336 | 0.354 | 0.345 | 100 | 98.4 |
annual household income | 0-25th percentile | 0.187 | 0.212 | 0.199 | 100 | 97.2 |
26th-50th percentile | 0.151 | 0.174 | 0.163 | 100 | 99.4 |
51st-75th percentile | 0.126 | 0.147 | 0.136 | 100 | 99.4 |
76th-100th percentile | 0.197 | 0.222 | 0.209 | 100 | 99.1 |
Meta-analysis
The readmission and re-operation prevalence :
In the 7trials reporting readmission rates, the overall pooled prevalence of readmission within 30 days was 10% (95% CI,9%,11% ,I2:93.5% ) (Fig. 2a). and the pooled prevalence of need for re-operation was 9% (95% CI,8%,10% ,I2:96.7% ) based on three articles reported this data(Fig. 2b)
Meta-analysis of prevalence of different types of payer in readmitted patients after epilepsy surgery:
The total prevalence of readmitted patients with Private payer, Medicaid and Medicare payers were 9.2%(95% CI,8.4%,9.9% ,I2:99.7% ), 4.7%(95% CI,4.1%,5.2% ,I2:99.6%), 8%(95% CI,7.3%,8.6% ,I2:99.7%), respectively.
Meta-analysis Of Prevalence Of Different Sizes Of Hospital Beds:
The total prevalence of readmitted patients with large beds and small or medium beds were 34.5%(95% CI,33.6%,35.4% ,I2:100% ), and 5.1%(95% CI,4.5%,5.6% ,I2:99.7%), respectively.
Meta-analysis of Median annual household income among readmitted patients after epilepsy surgery :
The total prevalence of readmitted patients with being in the 0-25th percentile, 26th -50th percentile and 51st -75th percentile were 19.9%(95% CI,18.7%,21.2% ,I2:99.2% ), 16.3%(95% CI,15.1%,17.4% ,I2:99.4%), 13.6%(95% CI,7.12.6%,14.7% ,I2:99.4%), respectively.
Meta-analysis of prevalence of surgical and medical complications in readmitted patients after epilepsy surgery:
The total prevalence of surgical and medical complications among readmitted patients after epilepsy surgery were 9.4%(95% CI,8.6%,10.2% ,I2:99.5% ), and 5%(95% CI,4.3%,5.7%), respectively.
Meta-analysis of the mean length of stay (LOS) among readmitted patients after epilepsy surgery:
The overall mean length of stay among readmitted patients after epilepsy surgery was 2.95 days.
Meta-analysis of the mean Elixhauser index among readmitted patients after epilepsy surgery:
The overall mean Elixhauser index among readmitted patients after epilepsy surgery was 8.05.
Meta-analysis of the prevalence of seizure as the most common cause of readmission among patients after epilepsy surgery:
The overall prevalence of seizure among readmitted patients after epilepsy surgery was 31.6%(95% CI,30.2%,32.9% ,I2:99.6% )
Meta-regression finding based on the mean of age and frequency of readmission:
The studies’ meta-regression was according to the association between frequency of readmission and the mean age of patients.There was no statistically significant linear trend in univariate meta-regression to explain effect size variation by mean of age of study with coefficient = 0.14 (95% CI − 2.17, 2.46), P = 0.88 (Fig. 3a).
Meta-regression finding based on the male to female ratio of study and prevalence of readmission:
The overall rate of readmissions based on the female to male ratio of the studies is showed in Figure. 4-b,the prevalence of readmission was lower in studies with higher male to female ratio. There was statistically significant linear trend in univariate meta-regression to explain effect size variation by male to female ratio of study with coefficient = 0.47 (95% CI 0.03, 162 0.91), P = 0.03. (Fig. 3b)
Meta-regression finding based on the mean of age and frequency of readmission:
The studies’ meta-regression was according to the association between frequency of readmission and the publication year of included studies.There was no statistically significant linear trend in univariate meta-regression to explain effect size variation by mean of age of study with coefficient = 0.14 (95% CI − 2.17, 2.46), P = 0.88 (Fig. 3c).
Publication Bias:
Funnel plot in Figure (3d) shows no indication of publication bias. It is shows in funnel plot symmetrically. Circles’ size shows the weight of studies (bigger circles shows more sample and smaller circles shows fewer sample).