A population-based study for 30-d hospital readmissions after acute ischemic stroke

Mittal, Manoj; Rabinstein, Alejandro A.; Mandrekar, Jay; Brown, Robert D.; Flemming, Kelly D.

doi:10.1080/00207454.2016.1207642

Cited by 19 publications

(17 citation statements)

References 34 publications

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“…This finding is consistent with that of a large US study, and smaller studies have also found similar trends. 3,152,232 In paper IV we demonstrate that a significantly higher proportion of patients readmitted within five years had died, compared to those who had not been readmitted. Readmissions later than 30 days after discharge probably also affect mortality.…”

Section: The Impact Of Hospital Readmissions On Mortalitymentioning

confidence: 82%

“…243 diabetes mellitus, heart failure, and dehydration, 230,231 whereas others have reviewed the medical records for determination of readmissions that could have been avoided. 152,248 Between 2% and 31% of all unplanned readmission within 30 days have been considered preventable. 152,230,231,248 However, the retrospective nature of these studies and the use of administrative data together with predefined categories of preventable causes limits the generalizability and impact of these studies.…”

Section: The Impact Of Hospital Readmissions On Mortalitymentioning

confidence: 99%

“…152,248 Between 2% and 31% of all unplanned readmission within 30 days have been considered preventable. 152,230,231,248 However, the retrospective nature of these studies and the use of administrative data together with predefined categories of preventable causes limits the generalizability and impact of these studies. In relation to our findings, many of the most frequent causes of both short-term and long-term readmission may be potentially preventable, such as fractures, infections, and thromboembolism.…”

Section: The Impact Of Hospital Readmissions On Mortalitymentioning

confidence: 99%

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Five-year readmission and mortality differ by ischemic stroke subtype

Bjerkreim

Khanevski

Thomassen

et al. 2019

Journal of the Neurological Sciences

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Background. Stroke aetiology may affect the risk and causes of readmission after ischaemic stroke (IS) and transient ischaemic attack (TIA) due to differences in risk factors, functional outcome, and treatment. We aimed to examine frequencies, causes, and risk of 30-day readmission by stroke subtype, determine predictors of 30-day readmission, and study the impact of 30-day readmissions on one-year mortality. Methods. All surviving patients admitted with IS or TIA from July 2007 to December 2013 were followed by review of medical records for all unplanned readmissions within 30 days after discharge. Stroke subtype was classified as largeartery atherosclerosis (LAA), cardioembolism (CE), small vessel occlusion (SVO), stroke of other determined aetiology (SOE), or stroke of undetermined aetiology (SUE). Cox regression analyses were performed to assess the risk of 30-day readmission for the stroke subtypes and identify predictors of 30-day readmission, and its impact on one-year mortality. Results. Of 1874 patients, 200 (10.7%) were readmitted within 30 days [LAA 42/244 (17.2%), CE 75/605 (12.4%), SVO 12/205 (5.9%), SOE 6/32 (18.8%), SUE 65/788 (8.3%)]. The most frequent causes of readmissions were stroke-related event, infection, recurrent stroke/ TIA, and cardiac disease. After adjusting for age, sex, functional outcome, length of stay, and the risk factor burden, patients with LAA and SOE subtype had significantly higher risks of readmission for any cause, recurrent stroke or TIA, and stroke-related events. Predictors of 30-day readmission were higher age, peripheral arterial disease, enteral feeding, and LAA subtype. Thirty-day readmission was an independent predictor of one-year mortality. Conclusions. Patients with LAA or SOE have a high risk of 30-day readmission, possibly caused by an increased risk of recurrent stroke and stroke-related events. Awareness of the risk of readmission for different causes and appropriate handling according to stroke subtype may be useful for preventing some readmissions after stroke.

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Section: The Impact Of Hospital Readmissions On Mortalitymentioning

confidence: 82%

Section: The Impact Of Hospital Readmissions On Mortalitymentioning

confidence: 99%

Section: The Impact Of Hospital Readmissions On Mortalitymentioning

confidence: 99%

See 1 more Smart Citation

Five-year readmission and mortality differ by ischemic stroke subtype

Bjerkreim

Khanevski

Thomassen

et al. 2019

Journal of the Neurological Sciences

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“…Also, the cause of readmission might contribute to a worse prognosis and higher post-stroke mortality, as demonstrated for post-stroke pneumonia and recurrent stroke [22, 23]. Even though most readmissions are unavoidable when reviewed retrospectively [24], a reduction in readmission rates have been demonstrated with early outpatient visits by physicians, and with education of patients about relevant diagnoses, and confirmation of the medication plan [25–27]. Sufficient monitoring and care for prevention of medical complications, both during hospitalisation and in the immediate post-hospital care setting, may be key factors in preventing some readmissions.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Ischaemic Stroke Subtype on 30-day Hospital Readmissions

Bjerkreim

Khanevski

Selvik

et al. 2018

Stroke Research and Treatment

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Background Stroke aetiology may affect the risk and causes of readmission after ischaemic stroke (IS) and transient ischaemic attack (TIA) due to differences in risk factors, functional outcome, and treatment. We aimed to examine frequencies, causes, and risk of 30-day readmission by stroke subtype, determine predictors of 30-day readmission, and study the impact of 30-day readmissions on one-year mortality. Methods All surviving patients admitted with IS or TIA from July 2007 to December 2013 were followed by review of medical records for all unplanned readmissions within 30 days after discharge. Stroke subtype was classified as large-artery atherosclerosis (LAA), cardioembolism (CE), small vessel occlusion (SVO), stroke of other determined aetiology (SOE), or stroke of undetermined aetiology (SUE). Cox regression analyses were performed to assess the risk of 30-day readmission for the stroke subtypes and identify predictors of 30-day readmission, and its impact on one-year mortality. Results Of 1874 patients, 200 (10.7%) were readmitted within 30 days [LAA 42/244 (17.2%), CE 75/605 (12.4%), SVO 12/205 (5.9%), SOE 6/32 (18.8%), SUE 65/788 (8.3%)]. The most frequent causes of readmissions were stroke-related event, infection, recurrent stroke/ TIA, and cardiac disease. After adjusting for age, sex, functional outcome, length of stay, and the risk factor burden, patients with LAA and SOE subtype had significantly higher risks of readmission for any cause, recurrent stroke or TIA, and stroke-related events. Predictors of 30-day readmission were higher age, peripheral arterial disease, enteral feeding, and LAA subtype. Thirty-day readmission was an independent predictor of one-year mortality. Conclusions Patients with LAA or SOE have a high risk of 30-day readmission, possibly caused by an increased risk of recurrent stroke and stroke-related events. Awareness of the risk of readmission for different causes and appropriate handling according to stroke subtype may be useful for preventing some readmissions after stroke.

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“…In our study, one-fifth (21.7%) of acute ischemic stroke (AIS) patients treated with IV-tPA were readmitted within 90 days of initial hospitalization, of which 20.6% were readmissions to non-index hospitals. Prior ischemic stroke studies have reported 7-12% 30-day readmission rates [12][13][14][15][16][17]. A large ischemic stroke hospital registry documented readmission rates of 10% at 30 days, 17% at 90 days, 24% at 180 days, and 36% at 360 days [18].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Rates and Outcomes of Readmission to Index vs Non-index Hospitals After Intravenous Thrombolysis in Acute Stroke Patients

Shkirkova¹,

Connor²,

Hodis³

et al. 2020

Cureus

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National and regional systems of stroke care are designed to provide patients with widespread access to hospitals with thrombolytic capabilities. However, such triaging systems may contribute to fragmentation of care. This study aims to compare rates of readmission and outcomes between index and non-index hospitals for stroke patients following intravenous thrombolytic therapy (IVT). This study utilized a nationally representative sample of stroke patients with IVT from the Nationwide Readmissions Database from 2010 to 2014. Descriptive and regression analyses were performed for patient and hospital level factors that influenced 90-day readmissions and regression models were used to identify differences in mortality, complications, and repeat readmissions between patients readmitted to index (facility where IVT was administered) and non-index hospitals. In the study, 49415 stroke patients were treated with IVT, of whom 21.7% were readmitted within 90 days. Among readmissions, 79.4% of patients were readmitted to index hospitals and 20.6% to non-index hospitals. On multivariate logistic regression analysis, index hospital readmission was independently associated with lower frequency of second readmissions (non-index OR 1.09, 95%CI 1.07-1.11, p<0.0001) but not with increased mortality or major complications (p=ns). Approximately onefifth of stroke patients treated with thrombolysis were readmitted within 90 days, one-fifth of whom were readmitted to non-index hospitals. Although readmission to index hospital was associated with lower frequency of subsequent readmissions, readmission to non-index hospital was not associated with increased mortality or major complications. This difference may be due to standardized algorithms, mature systems of care, and demanding metrics required of stroke centers.

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A population-based study for 30-d hospital readmissions after acute ischemic stroke

Cited by 19 publications

References 34 publications

Five-year readmission and mortality differ by ischemic stroke subtype

Five-year readmission and mortality differ by ischemic stroke subtype

The Impact of Ischaemic Stroke Subtype on 30-day Hospital Readmissions

Comparison of Rates and Outcomes of Readmission to Index vs Non-index Hospitals After Intravenous Thrombolysis in Acute Stroke Patients

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