Farhaan S Vahidy1, John P Donnelly2, Louise D McCullough2, Jon E Tyson2, Charles C Miller2, Amelia K Boehme2, Sean I Savitz2, Karen C Albright2. 1. From the Department of Neurology, McGovern Medical School, University of Texas Health Science Center, Houston (F.S.V., L.D.M., S.I.S.); Department of Emergency Medicine (J.P.D.) and Department of Neurology (K.C.A.), University of Alabama School of Medicine, Birmingham; Center for Clinical Research and Evidence-Based Medicine, McGovern Medical School, University of Texas Health Science Center, Houston (J.E.T., C.C.M.); and Department of Neurology, Columbia University, New York, NY (A.K.B.). Farhaan.Vahidy@uth.tmc.edu. 2. From the Department of Neurology, McGovern Medical School, University of Texas Health Science Center, Houston (F.S.V., L.D.M., S.I.S.); Department of Emergency Medicine (J.P.D.) and Department of Neurology (K.C.A.), University of Alabama School of Medicine, Birmingham; Center for Clinical Research and Evidence-Based Medicine, McGovern Medical School, University of Texas Health Science Center, Houston (J.E.T., C.C.M.); and Department of Neurology, Columbia University, New York, NY (A.K.B.).
Abstract
BACKGROUND AND PURPOSE: Readmission within 30 days of hospital discharge for ischemic stroke is an important quality of care metric. We aimed to provide nationwide estimates of 30-day readmission in the United States, describe important reasons for readmission, and sought to explore factors associated with 30-day readmission, particularly the association with recanalization therapy. METHODS: We conducted a weighted analysis of the 2013 Nationwide Readmission Database to represent all US hospitalizations. Adult patients with acute ischemic stroke including those who received intravenous tissue-type plasminogen activator and intra-arterial therapy were identified using International Classification of Diseases-Ninth Revision codes. Readmissions were defined as any readmission during the 30-day post-index hospitalization discharge period for the eligible patient population. Proportions and 95% confidence intervals for overall 30-day readmissions and for unplanned and potentially preventable readmissions are reported. Survey design logistic regression models were fit for determining crude and adjusted odds ratios and 95% confidence interval for association between recanalization therapy and 30-day readmission. RESULTS: Of the 319 317 patients with acute ischemic stroke, 12.1% (95% confidence interval, 11.9-12.3) were readmitted. Of these, 89.6% were unplanned and 12.9% were potentially preventable. More than 20% of all readmissions were attributable to acute cerebrovascular disease. Readmitted patients were older and had a higher comorbidity burden. After controlling for age, sex, insurance status, and comorbidities, patients who underwent recanalization therapy had significantly lower odds of 30-day readmission (odds ratio, 0.82; 95% confidence interval, 0.77-0.89). CONCLUSIONS: Up to 12% of patients with ischemic stroke get readmitted within 30 days post-discharge period, and recanalization therapy is associated with 11% to 23% lower odds of 30-day readmission.
BACKGROUND AND PURPOSE: Readmission within 30 days of hospital discharge for ischemic stroke is an important quality of care metric. We aimed to provide nationwide estimates of 30-day readmission in the United States, describe important reasons for readmission, and sought to explore factors associated with 30-day readmission, particularly the association with recanalization therapy. METHODS: We conducted a weighted analysis of the 2013 Nationwide Readmission Database to represent all US hospitalizations. Adult patients with acute ischemic stroke including those who received intravenous tissue-type plasminogen activator and intra-arterial therapy were identified using International Classification of Diseases-Ninth Revision codes. Readmissions were defined as any readmission during the 30-day post-index hospitalization discharge period for the eligible patient population. Proportions and 95% confidence intervals for overall 30-day readmissions and for unplanned and potentially preventable readmissions are reported. Survey design logistic regression models were fit for determining crude and adjusted odds ratios and 95% confidence interval for association between recanalization therapy and 30-day readmission. RESULTS: Of the 319 317 patients with acute ischemic stroke, 12.1% (95% confidence interval, 11.9-12.3) were readmitted. Of these, 89.6% were unplanned and 12.9% were potentially preventable. More than 20% of all readmissions were attributable to acute cerebrovascular disease. Readmitted patients were older and had a higher comorbidity burden. After controlling for age, sex, insurance status, and comorbidities, patients who underwent recanalization therapy had significantly lower odds of 30-day readmission (odds ratio, 0.82; 95% confidence interval, 0.77-0.89). CONCLUSIONS: Up to 12% of patients with ischemic stroke get readmitted within 30 days post-discharge period, and recanalization therapy is associated with 11% to 23% lower odds of 30-day readmission.
Authors: Michelle H Leppert; Stefan Sillau; Richard C Lindrooth; Sharon N Poisson; Jonathan D Campbell; Jennifer R Simpson Journal: Neurology Date: 2020-02-20 Impact factor: 9.910
Authors: John W Liang; Laura Cifrese; Lili Velickovic Ostojic; Syed O Shah; Mandip S Dhamoon Journal: Neurocrit Care Date: 2018-12 Impact factor: 3.210
Authors: Ian A Buchanan; Michelle Lin; Daniel A Donoho; Arati Patel; Li Ding; Arun P Amar; Steven L Giannotta; William J Mack; Frank Attenello Journal: World Neurosurg Date: 2018-11-20 Impact factor: 2.104
Authors: Amit Kumar; Linda Resnik; Amol Karmarkar; Janet Freburger; Deepak Adhikari; Vincent Mor; Pedro Gozalo Journal: Arch Phys Med Rehabil Date: 2019-01-24 Impact factor: 3.966
Authors: Addie Middleton; Yong-Fang Kuo; James E Graham; Amol Karmarkar; Yu-Li Lin; James S Goodwin; Allen Haas; Kenneth J Ottenbacher Journal: J Am Med Dir Assoc Date: 2018-10 Impact factor: 4.669