Background: Recent trials have demonstrated a reduction in death or disability with endovascular treatment in patients with acute ischemic strokes. However, readmission rates and predictors are not known. Objective: To identify rates and factors associated with 30-day readmission after endovascular treatment in ischemic stroke patients. Methods: Nationwide Readmissions Data (NRD) between 2010 and 2017 was utilized to identify endovascular treatment in acute ischemic stroke patients using ICD-9 and ICD-10 codes. We used hierarchical logistic regression model to identify factors associated with 30-day readmissions. Results: Among 17, 562 acute ischemic stroke patients who survived to discharge after endovascular treatment, 2334 (13.29%) were readmitted within 30-days. Age => 65 years (odds ratio [OR]: 1.23, 95% confidence interval [CI]: 1.09 to 1.39, p =0.0005), chronic kidney disease (OR: 1.28, 95%CI: 1.12 to 1.47, p = 0.0004), congestive heart failure (OR: 1.25, 95%CI: 1.13 to 1.39, p <.0001), post procedure intracranial hemorrhage (OR: 1.09, 95%CI: 0.99 to 1.20, p = 0.04) and diabetes mellitus (OR: 1.09, 95%CI: 0.99 to 1.20, p = .09) during the index hospitalization were associated with readmission within 30 days. Conclusion: In this large nationally representative study, nearly one in 10 patients were readmitted within 30 days after discharge in acute ischemic stroke patients undergoing endovascular treatment. Medical comorbidities and post procedure intracranial hemorrhage were associated with 30-day readmission.

ObjectiveTo identify the beneficial effects of thrombectomy capable hospitals (TCHs), by comparing the incidence of in-hospital adverse events and discharge outcomes among patients with ischemic stroke treated at thrombectomy capable and non-thrombectomy capable hospitals in the United States.MethodsWe used the data from the Nationwide Inpatient Sample from January 2012 to December 2017. Thrombectomy capable hospitals were identified based on the number of thrombectomy procedures performed by a hospital each year among patients with ischemic stroke. If a hospital performed 10 or more thrombectomy procedures, it was labelled a TCH. The inclusion criteria were age ≥18 years, and ischemic stroke (International Classification of Diseases 433 .x1-434.x1 (ICD-9) or I63 (ICD-10)) as primary discharge diagnosis. A comparative analysis of propensity-matched patient groups was done to study the influence of TCH admissions on in-hospital outcomes.ResultsA total of 2 826 334 patients with primary ischemic stroke were identified. In a multivariate logistic regression model after adjusting for age, sex, race/ethnicity, hospital teaching status, comorbidities, and all patients refined diagnosis-related groups-based disease severity, patients admitted to a TCH were found to have low incidence of in-hospital adverse events: pneumonia (OR=0.86, 95% CI 0.78 to 0.93), urinary tract infection (OR=0.87, 95% CI 0.84 to 0.91), sepsis (OR=0.91, 95% CI 0.81 to 1.02), and pulmonary embolism (OR=0.89, 95% CI 0.77 to 1.03); in-hospital death (OR=0.82, 95% CI 0.78 to 0.88); and higher rate of home discharge (OR=1.09, 95% CI 1.06 to 1.12).ConclusionsA decrease in-hospital adverse events and improved discharge outcomes were observed among patients with ischemic stroke admitted to a TCH compared with a non-TCH.

Background: Avoidance of readmission is linked to improved quality of care, reduction in cost, and is a desirable patient-centered outcome. Nationally representative readmission metrics for patients with acute ischemic stroke treated with intravenous thrombolytic treatment (IV-tPA) are unavailable to date. Such estimates are necessary for benchmarking performance. Objectives: To identify US nationwide estimates and a temporal trend for 30-day hospital readmissions. Methods: We identified the cohort by year-wise analysis of the Nationwide Readmissions Database between January 1, 2010, and September 30, 2015. The database represents 50% of all US hospitalizations from 22 geographically dispersed states. Participants were adult (=>18 years) patients with a primary discharge diagnosis of acute ischemic (ICD-9-CM 433.x1 and 434.x1) who were treated with thrombolytic therapy (ICD-9-CM 9910). Readmission was defined as any admission within 30 days of index hospitalization discharge. Results: Based on study criteria, 57,676 eligible patients were included (mean [SE] age, 68.7 ± 14.4 years; 48.7% were women). Thirty-day readmission rate for acute ischemic stroke patients treated with IV-tPA was 11.17 % (95%CI, 10.92 %-11.43%). On average, there was a 4.4% annual decline in readmission between 2010 and 2014, which was statistically significant for the period of investigation (odds ratio, 0.95; 95%CI, 0.94-0.97). Age ≥ 65 years (OR 1.16 P <.0001), medical history of congestive heart failure (OR 1.11 P = 0.0056), chronic lung disease (OR 1.11 P = 0.0034) and renal failure (OR 1.35 P = <.0001) were independent predictors of readmission within 30 days. Conclusion: Nationally representative readmission metrics can be used to benchmark hospitals’ performance, and a temporal trend of 4.4 % may be used to evaluate the effectiveness of readmission reduction strategies.

Background: To identify the beneficial effects of thrombectomy capable hospitals (TCHs), we compared the rates of in-hospital adverse events and discharge outcomes among ischemic stroke patients admitted to thrombectomy capable and non-thrombectomy capable hospitals in the United States. Methods: We obtained the data from the Nationwide Inpatient Sample from 2012 and 2017. Thrombectomy capable hospitals were identified based on number of thrombectomy procedures performed by hospital per year among ischemic stroke patients. If an hospital performed ten or more thrombectomy procedures, it was labelled as thrombecotomy capable hospital. The analysis was limited to patients (age ≥18 years) discharged with a principal diagnosis of ischemic stroke (International Classification of Disease 433.x1-434.x1 (ICD-9) or I63 (ICD-10). The impact of TCHs admissions on in-hospital outcomes was assessed in a comparative analysis of propensity-matched groups of patients. Results: We identified a total of 2,826,335 patients with primary ischemic stroke patients. After adjusting for age, gender, race or ethnicity, comorbidities, All Patients Refined Diagnosis Related Groups (APR-DRG)-based disease severity, and hospital teaching status, patients admitted to TCHs were at lower risk of in-hospital adverse events complications: pneumonia (odds ratio [OR], 0.86; 95% confidence interval [CI], 0.80-0.93), urinary tract infection (OR, 0.87; 95% CI, 0.84-0.91)and sepsis (OR, 0.92; 95% CI, 0.84-1.00). Patients admitted to TCH were more likely to receive thrombolysis (OR, 1.29; 95% CI, 1.30-1.36). The mean cost of hospitalization of the patients was significantly higher in patients admitted at TCHs compared with those admitted at non-thrombectomy capable $74765 vs $60530, P < .0001). The patients admitted to TCHs had lower inpatient mortality (OR, 0.82; 95% CI, 0.78-.88) and were more likely to be discharged with none to minimal disability (OR, 1.09; 95% CI, 1.06-1.12). Conclusions: Compared with non-thrombectomy capable admissions, patients admitted to TCHs are less likely to experience hospital adverse events and more likely to experience better discharge outcomes.