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

Abstract

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.

Readmission Rates Among Acute Reperfusion Treatment Modalities for Patients With Ischemic Stroke

“…Investigations have mainly focused on all-cause readmission at 30 and 90-day range. To our knowledge, no studies have examined whether hospital readmission rates change when comparing between IV rtPA 10 and EVT patients. 17 Vahidy et al, 12 provided an estimate of 12.1% readmission within 30 days post-discharge period across all treatment modalities using the 2013 Nationwide Readmission Database (NRD).…”

“…9 Its use is associated with beneficial outcomes reducing mortality rates and improving functional outcomes for early treatment (within 90 min), and favorable for later treatment (at 90-180 min). 10,11 However, a single pharmacological agent is not always effective to re-canalize occluded major brain arteries; multimodal therapeutic strategy is often required to produce the desired improvement in cerebral blood flow.…”