Swee Hung Ang1, Wen Yea Hwong1,2, Michiel L Bots2, Sheamini Sivasampu1, Aznida Firzah Abdul Aziz3, Fan Kee Hoo4, Ilonca Vaartjes2. 1. Institute for Clinical Research, National Institutes of Health, Ministry of Health, Selangor, Malaysia. 2. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. 3. Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Selangor, Malaysia. 4. Neurology Unit, Department of Medicine, Faculty of Medicine, Universiti Putra Malaysia, Selangor, Malaysia.
Abstract
BACKGROUND AND OBJECTIVES: Risk of readmissions is an important quality indicator for stroke care. Such information is limited among low- and middle-income countries. We assessed the trends for 28-day readmissions after a stroke in Malaysia from 2008 to 2015 and evaluated the causes and factors associated with readmissions in 2015. METHODS: Using the national hospital admission records database, we included all stroke patients who were discharged alive between 2008 and 2015 for this secondary data analysis. The risk of readmissions was described in proportion and trends. Reasons were coded according to the International Classification of Diseases, 10th Edition. Multivariable logistic regression was performed to identify factors associated with readmissions. RESULTS: Among 151729 patients, 11 to 13% were readmitted within 28 days post-discharge from their stroke events each year. The trend was constant for ischemic stroke but decreasing for hemorrhagic stroke. The leading causes for readmissions were recurrent stroke (32.1%), pneumonia (13.0%) and sepsis (4.8%). The risk of 28-day readmission was higher among those with stroke of hemorrhagic (adjusted odds ratio (AOR): 1.52) and subarachnoid hemorrhage (AOR: 2.56) subtypes, and length of index admission >3 days (AOR: 1.48), but lower among younger age groups of 35-64 (AORs: 0.61-0.75), p values <0.001. CONCLUSION: The risk of 28-day readmission remained constant from 2008 to 2015, where one in eight stroke patients required readmission, mainly attributable to preventable causes. Age, ethnicity, stroke subtypes and duration of the index admission influenced the risk of readmission. Efforts should focus on minimizing potentially preventable admissions, especially among those at higher risk.
BACKGROUND AND OBJECTIVES: Risk of readmissions is an important quality indicator for stroke care. Such information is limited among low- and middle-income countries. We assessed the trends for 28-day readmissions after a stroke in Malaysia from 2008 to 2015 and evaluated the causes and factors associated with readmissions in 2015. METHODS: Using the national hospital admission records database, we included all strokepatients who were discharged alive between 2008 and 2015 for this secondary data analysis. The risk of readmissions was described in proportion and trends. Reasons were coded according to the International Classification of Diseases, 10th Edition. Multivariable logistic regression was performed to identify factors associated with readmissions. RESULTS: Among 151729 patients, 11 to 13% were readmitted within 28 days post-discharge from their stroke events each year. The trend was constant for ischemic stroke but decreasing for hemorrhagic stroke. The leading causes for readmissions were recurrent stroke (32.1%), pneumonia (13.0%) and sepsis (4.8%). The risk of 28-day readmission was higher among those with stroke of hemorrhagic (adjusted odds ratio (AOR): 1.52) and subarachnoid hemorrhage (AOR: 2.56) subtypes, and length of index admission >3 days (AOR: 1.48), but lower among younger age groups of 35-64 (AORs: 0.61-0.75), p values <0.001. CONCLUSION: The risk of 28-day readmission remained constant from 2008 to 2015, where one in eight strokepatients required readmission, mainly attributable to preventable causes. Age, ethnicity, stroke subtypes and duration of the index admission influenced the risk of readmission. Efforts should focus on minimizing potentially preventable admissions, especially among those at higher risk.
Authors: Monique F Kilkenny; Mark Longworth; Michael Pollack; Christopher Levi; Dominique A Cadilhac Journal: Stroke Date: 2013-06-25 Impact factor: 7.914
Authors: Sonia V Shah; Carlos Corado; Deborah Bergman; Yvonne Curran; Richard A Bernstein; Andrew M Naidech; Shyam Prabhakaran Journal: J Stroke Cerebrovasc Dis Date: 2015-07-10 Impact factor: 2.136
Authors: Farhaan S Vahidy; John P Donnelly; Louise D McCullough; Jon E Tyson; Charles C Miller; Amelia K Boehme; Sean I Savitz; Karen C Albright Journal: Stroke Date: 2017-04-07 Impact factor: 7.914
Authors: Jay G Berry; James C Gay; Karen Joynt Maddox; Eric A Coleman; Emily M Bucholz; Margaret R O'Neill; Kevin Blaine; Matthew Hall Journal: BMJ Date: 2018-02-27