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

Abstract

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.

Risk factors for 30-day readmission in patients with ischemic stroke: a systematic review and meta-analysis

“…The 30-day readmission rates of ischemic stroke survivors ranged from 1.41% to 27.64%, with a mean value of 10.66% (SD 6.87%). The results varied across countries and regions, with the highest reported 30-day readmission rate from China (11) and the lowest from the United States (12), which is consistent with the results of previous systematic reviews and meta-analyses (2,4,7,(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27). Many risk factors can contribute to 30-day readmission in patients with ischemic stroke.…”

“…These 2 investigators also independently assessed study quality using methods developed by the US Agency for Healthcare Research and Quality (AHRQ), while the Newcastle-Ottawa Scale was applied for observational studies. Study quality scores were defined as poor [0-3], fair [4][5][6], or good [7][8][9]. Discrepancies encountered during literature screening, data extraction, and quality assessment were discussed and resolved in consultation with a third author (YR), if necessary.…”

“…The high readmission rate reduces the quality of life of patients, causes considerable harm to patients and their families, and increases the medical and economic burden. It is also important to investigate the 15-or 60-day readmission rates of patients with ischemic stroke, but the study of Bjerkreim et al (4) showed that 30-day readmission significantly increased the risk of 1-year mortality in patients surviving 30 days after discharge. Furthermore, the frequency of 30-day readmissions after stroke has become an indicator for the quality of care, quality of immediate post-discharge care, and the presence of a chronically ill and vulnerable population (5).…”

Short-Term Outcome and In-Hospital Complications After Acute Cerebral Infarcts in Multiple Arterial Territories

“…Ongoing embolization not only leads to a higher total risk of recurrence, but also leads to a higher risk of recurrence within the first 30 days. 139,166 In Paper-II, we also conducted a sub-analysis aiming at patients with MACI solely in the anterior circulation and with concomitant symptomatic or asymptomatic ICA stenosis. In the cohort of patients with MACI in the anterior circulation only (N=93), there were 25 patients with ICA stenosis, all of them had symptomatic ICA stenosis on at least one side, and no patient had only asymptomatic ICA stenosis(es).…”

Risk of 28-day readmissions among stroke patients in Malaysia (2008–2015): Trends, causes and its associated factors

“…Furthermore, existing studies on stroke readmissions were mostly conducted in HICs. Rates of 30-day readmissions in these countries varied from 6.5% in Australia to 11% in Norway and 12% in the US [ 7 , 13 , 17 ]. In Asia, there was limited information on the rate of readmissions after a stroke discharge.…”