High Mortality among 30-Day Readmission after Stroke: Predictors and Etiologies of Readmission

Abstract

BackgroundAlthough some risk factors for stroke readmission have been reported, the mortality risk is unclear. We sought to evaluate etiologies and predictors of 30-day readmissions and determine the associated mortality risk.MethodsThis is a retrospective case–control study evaluating 1,544 patients admitted for stroke (hemorrhagic, ischemic, or TIA) from January 2013 to December 2014. Of these, 134 patients readmitted within 30 days were identified as cases; 1,418 other patients, with no readmissions were identified as controls. Patients readmitted for hospice or elective surgery were excluded. An additional 248 patients deceased on index admission were included for only a comparison of mortality rates. Factors explored included socio-demographic characteristics, clinical comorbidities, stroke characteristics, and length of stay. Chi-square test of proportions and multivariable logistic regression were used to identify independent predictors of 30-day stroke readmissions. Mortality rates were compared for index admission and readmission and among readmission diagnoses.ResultsAmong the 1,544 patients in the main analysis, 67% of index stroke admissions were ischemic, 22% hemorrhagic, and 11% TIA. The 30-day readmission rate was 8.7%. The most common etiologies for readmission were infection (30%), recurrent stroke and TIA (20%), and cardiac complications (14%). Significantly higher proportion of those readmitted for recurrent strokes and TIAs presented within the first week (p = 0.039) and had a shorter index admission length of stay (p = 0.027). Risk factors for 30-day readmission included age >75 (p = 0.02), living in a facility prior to index stroke (p = 0.01), history of prior stroke (p = 0.03), diabetes (p = 0.03), chronic heart failure (p ≤ 0.001), atrial fibrillation (p = 0.03), index admission to non-neurology service (p < 0.01), and discharge to other than home (p < 0.01). On multivariate analysis, index admission to a non-neurology service was an independent predictor of 30-day readmission (p ≤ 0.01). The mortality after a within 30-day readmission after stroke was higher than index admission (36.6 vs. 13.8% p ≤ 0.001) (OR 3.6 95% CI 2.5–5.3). Among those readmitted, mortality was significantly higher for those admitted for a recurrent stroke (p = 0.006).ConclusionApproximately one-third of 30-day readmissions were infection related and one-fifth returned with recurrent stroke or TIA. Index admission to non-neurology service was an independent risk factor of 30-day readmissions. The mortality rate for 30-day readmission after stroke is more than 2.5 times greater than index admissions and highest among those readmitted for recurrent stroke. Identifying high-risk patients for readmission, ensuring appropriate level of service, and early outpatient follow-up may help reduce 30-day readmission and the high associated risk of mortality.

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

“…Stroke treatment has improved considerably over the last decades, but 30-day readmission rates after stroke have remained unchanged in Norway [1]. Thirty-day readmission rates range from 6.0% to 15.0%, with infections, recurrent stroke, and cardiac conditions as leading causes [1–8]. Reducing 30-day readmission is an important target in reducing post-stroke morbidity, mortality, and health care costs [9].…”

Annual incidences and predictors of 30-day readmissions following spontaneous intracerebral hemorrhage from 2010 to 2014 in the United States: A retrospective Nationwide analysis

“…Infection accounted for the second most number of readmissions. In prior studies, infection has been associated with the greatest number of readmissions after sICH [2,15,16], and among patients with ischemic stroke, infection has also been shown to be the leading reason for 30dRAs [19]. At least one study has shown that readmissions due to infection are associated with higher mortality than other causes of readmission [16].…”

“…Stroke was recently added to the list of conditions in which 30dRAs are penalized by the ACA, which prompted numerous studies that analyzed readmission rates for various cerebrovascular insults [1,2,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26]. Despite recent efforts, there remains limited knowledge regarding annual trends and risk factors for 30dRA among patients with spontaneous intracerebral hemorrhage (sICH).…”

Thirty-Day Hospital Readmissions: A Predictor of Higher All-cause Mortality for Up to Two Years

“…Scaglione et al reported that 50% of patients admitted for decompensated cirrhosis had 30-day readmissions resulting in higher 90-day, one-year, and overall mortality rates [10]. Nouh et al reported a 30-day readmission rate of 8.7% in the case of stroke patients, associated with high mortality of 36.6 % vs. 14% (OR 3.6) in readmitted vs. not readmitted, but these patients were not followed up prospectively [11]. Our study is different from the above studies in that we are investigating all-cause readmissions and not those related to any single disease process, even though the theme of higher mortality rates in the readmitted patients is constant with our results.…”