Preethi Ramchand1, Dylan P Thibault2, James A Crispo3, Joshua Levine4, Robert Hurst5, Michael T Mullen3, Scott Kasner3, Allison W Willis6. 1. Department of Neurocritical Care, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. Electronic address: Preethi.Ramchand@uphs.upenn.edu. 2. Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Neurology Translational Center of Excellence for Neuroepidemiology and Outcomes Research, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. 3. Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. 4. Department of Neurocritical Care, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. 5. Department of Neuroradiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. 6. Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Neurology Translational Center of Excellence for Neuroepidemiology and Outcomes Research, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Biostatistics Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
Abstract
OBJECTIVE: Mechanical thrombectomy after acute ischemic stroke has been shown to improve clinical outcomes. Data on short-term hospitalization outcomes after thrombectomy are needed. Our objective was to quantify 30- and 90-day readmissions after thrombectomy and identify factors associated with readmissions. METHODS: Retrospective observational analysis of adult patients hospitalized between January and November 2014, using data from the 2014 Nationwide Readmissions Database. Readmission rates were calculated and examined according to patient, clinical, and hospital characteristics using descriptive statistics. Weighted unconditional logistic regression models estimated the odds of readmission and examine the associations between select characteristics and readmission. RESULTS: 4850 individuals who underwent mechanical thrombectomy for acute ischemic stroke in 2014 were eligible for 30-day readmissions analyses. The nonelective readmission rate was 12.5% at 30 days, 20.7% at 90 days. Sepsis and stroke were the most common reasons for readmission. Female sex (adjusted odds ratio [AOR] 1.34, 1.02-1.77 at 30 days), discharge to inpatient postacute care facility (AOR 1.61, 1.07-2.41 at 30 days, AOR 1.99, 1.47-2.69 at 90 days), and longer initial length of stay (AOR 1.52, 1.04-2.23 at 30 days, AOR 1.67, 1.14-2.43 at 90 days) were associated with a higher likelihood of readmission. Thrombectomy complications were rare and not associated with readmission. CONCLUSIONS: 1 in 8 thrombectomy patients had a short-term readmission in 2014. Characteristics suggestive of a complicated hospital course or greater physical disability were the primary predictors of readmission. This study provides preliminary data for evaluations of the public health impact of mechanical thrombectomy in real world settings.
OBJECTIVE: Mechanical thrombectomy after acute ischemic stroke has been shown to improve clinical outcomes. Data on short-term hospitalization outcomes after thrombectomy are needed. Our objective was to quantify 30- and 90-day readmissions after thrombectomy and identify factors associated with readmissions. METHODS: Retrospective observational analysis of adult patients hospitalized between January and November 2014, using data from the 2014 Nationwide Readmissions Database. Readmission rates were calculated and examined according to patient, clinical, and hospital characteristics using descriptive statistics. Weighted unconditional logistic regression models estimated the odds of readmission and examine the associations between select characteristics and readmission. RESULTS: 4850 individuals who underwent mechanical thrombectomy for acute ischemic stroke in 2014 were eligible for 30-day readmissions analyses. The nonelective readmission rate was 12.5% at 30 days, 20.7% at 90 days. Sepsis and stroke were the most common reasons for readmission. Female sex (adjusted odds ratio [AOR] 1.34, 1.02-1.77 at 30 days), discharge to inpatient postacute care facility (AOR 1.61, 1.07-2.41 at 30 days, AOR 1.99, 1.47-2.69 at 90 days), and longer initial length of stay (AOR 1.52, 1.04-2.23 at 30 days, AOR 1.67, 1.14-2.43 at 90 days) were associated with a higher likelihood of readmission. Thrombectomy complications were rare and not associated with readmission. CONCLUSIONS: 1 in 8 thrombectomy patients had a short-term readmission in 2014. Characteristics suggestive of a complicated hospital course or greater physical disability were the primary predictors of readmission. This study provides preliminary data for evaluations of the public health impact of mechanical thrombectomy in real world settings.