Frequency, predictors, and outcomes of readmission to index versus non-index hospitals after mechanical thrombectomy in patients with ischemic stroke

Shkirkova, Kristina; Connor, Michelle; Lamorie‐Foote, Krista; Patel, Arati; Liu, Qinghai; Ding, Li; Amar, Arun Paul; Sanossian, Nerses; Attenello, Frank J.; Mack, William J.

doi:10.1136/neurintsurg-2019-015085

Cited by 4 publications

(1 citation statement)

References 23 publications

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“…Furthermore, Shkirkova et al also studied 2111 patients from 2010 to 2014 through the NRD and reported a 90-day readmission rate of 25.3%. 16 The variability in the rates in these studies is likely due to the use of a national registry that includes institutions with varying mechanical thrombectomy expertise, critical care resources, and rehabilitation/outpatient clinic networks. The 3 most common causes of readmission were septicemia (5.9%), atrial fibrillation (4.8%), and recurrent stroke (4.8%).…”

Section: Reason For Readmissionmentioning

confidence: 99%

Predictors of 30-day hospital readmission after mechanical thrombectomy for acute ischemic stroke

Mouchtouris

Saiegh

Valcarcel

et al. 2021

Journal of Neurosurgery

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OBJECTIVEThe 30-day readmission rate is of increasing interest to hospital administrators and physicians, as it is used to evaluate hospital performance and is associated with increased healthcare expenditures. The estimated yearly cost to Medicare of readmissions is $17.4 billion. The Centers for Medicare and Medicaid Services therefore track unplanned 30-day readmissions and institute penalties against hospitals whose readmission rates exceed disease-specific national standards. One of the most important conditions with potential for improvement in cost-effective care is ischemic stroke, which affects 795,000 people in the United States and is a leading cause of death and disability. Recent widespread adoption of mechanical thrombectomy has revolutionized stroke care, requiring reassessment of readmission causes and costs in this population.METHODSThe authors retrospectively analyzed a prospectively maintained database of stroke patients and identified 561 patients who underwent mechanical thrombectomy between 2010 and 2019 at the authors’ institution. Univariate and multivariate analyses were conducted to identify clinical variables and comorbidities related to 30-day readmissions in this patient population.RESULTSOf the 561 patients, 85.6% (n = 480) survived their admission and were discharged from the hospital to home or rehabilitation, and 8.8% (n = 42/480) were readmitted within 30 days. The mean time to readmission was 10.9 ± 7.9 days postdischarge. The most common reasons for readmission were infection (33.3%) and acute cardiac or cerebrovascular events (19% and 20%, respectively). Multivariate analysis showed that hypertension (p = 0.030; OR 2.72) and length of initial hospital stay (p = 0.040; OR 1.032) were significantly correlated with readmission within 30 days, while hemorrhagic conversion (grades 3 and 4) approached significance (p = 0.053; OR 2.23). Other factors, such as unfavorable outcome at discharge, history of coronary artery disease, and discharge destination, did not predict readmission.CONCLUSIONSThe study data demonstrate that hypertension, length of hospital stay, and hemorrhagic conversion were predictors of 30-day hospital readmission in stroke patients after mechanical thrombectomy. Infection was the most common cause of 30-day readmission, followed by cardiac and cerebrovascular diagnoses. These results therefore may serve to identify patients within the stroke population who require increased surveillance following discharge to reduce complications and unplanned readmissions.

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Section: Reason For Readmissionmentioning

confidence: 99%

Predictors of 30-day hospital readmission after mechanical thrombectomy for acute ischemic stroke

Mouchtouris

Saiegh

Valcarcel

et al. 2021

Journal of Neurosurgery

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External validation and comparative analysis of the HOSPITAL score and LACE index for predicting readmissions among patients hospitalised with community-acquired pneumonia in Australia

Sharma,

Mangoni,

Horwood

et al. 2024

Aust. Health Rev.

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Objective Community-acquired pneumonia (CAP) is a leading cause of emergency hospitalisations globally and is associated with high readmission rates. Specific score systems developed for all medical conditions such as the HOSPITAL score and the LACE index can also usefully predict CAP readmissions. However, there is limited evidence regarding their performance in the Australian healthcare settings. Methods This multicentre retrospective study analysed adult CAP discharges from two metropolitan hospitals in South Australia between 1 January 2018 and 31 December 2023. Data for determining the HOSPITAL score and the LACE index were derived from electronic medical records. Demographic characteristics of patients readmitted within 30 days were compared with those who were not readmitted. The scores were evaluated for overall performance, discriminatory power and calibration, with discriminatory power assessed using the concordance statistic (C-statistic). Results Over 6 years, 7245 CAP discharges were recorded, with 1329 (18.3%) readmissions within 30 days. The mean (s.d.) age of the cohort was 74.4 (17.8) years. Readmitted patients were more likely to have multiple morbidities and frailty than those not readmitted (P < 0.05). They also had a higher mean number of emergency department presentations and hospital admissions in the previous year and a longer initial hospital stay (P < 0.05). Overall, the mean (s.d.) HOSPITAL score and LACE index were 3.4 (2.1) and 9.3 (3.6), respectively. Among readmissions, 28.4% occurred in patients with a HOSPITAL score >4 (intermediate and high-risk group), while 25.8% occurred in patients in the high-risk LACE category (LACE index > 10). The C-statistic for the HOSPITAL score and LACE index was 0.62 (95% CI 0.61–0.64) and 0.63 (95% CI 0.61–0.65), respectively, with no significant difference in the area under the receiver operating characteristic curves (P > 0.05). Conclusions The predictive abilities of the HOSPITAL score and the LACE index for CAP readmissions are modest and comparable in an Australian setting.

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Drivers of variation in 90-day episode payments after mechanical thrombectomy for acute ischemic stroke

Daou

Yost

Syrjamaki

et al. 2020

J NeuroIntervent Surg

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BackgroundAlthough mechanical thrombectomy for acute ischemic stroke from a large vessel occlusion is now the standard of care, little is known about cost variations in stroke patients following thrombectomy and factors that influence these variations.MethodsWe evaluated claims data for 2016 to 2018 for thrombectomy-performing hospitals within Michigan through a registry that includes detailed episode payment information for both Medicare and privately insured patients. We aimed to analyze price-standardized and risk-adjusted 90-day episode payments in patients who underwent thrombectomy. Hospitals were grouped into three payment terciles for comparison. Statistical analysis was carried out using unpaired t-test, Chi-square, and ANOVA tests.Results1076 thrombectomy cases treated at 16 centers were analyzed. The average 90-day episode payment by hospital ranged from $53 046 to $81,767, with a mean of $65 357. A $20 467 difference (35.1%) existed between the high and low payment hospital terciles (P<0.0001), highlighting a significant payment variation across hospital terciles. The primary drivers of payment variation were related to post-discharge care which accounted for 38% of the payment variation (P=0.0058, inter-tercile range $11,977–$19,703) and readmissions accounting for 26% (P=0.016, inter-tercile range $3,315–$7,992). This was followed by professional payments representing 20% of the variation (P<0.0001, inter-tercile range $7525–$9,922), while index hospitalization payment was responsible for only 16% of the 90-day episode payment variation (P=0.10, inter-tercile range $35,432–$41,099).ConclusionsThere is a wide variation in 90-day episode payments for patients undergoing mechanical thrombectomy across centers. The main drivers of payment variation are related to differences in post-discharge care and readmissions.

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Frequency, predictors, and outcomes of readmission to index versus non-index hospitals after mechanical thrombectomy in patients with ischemic stroke

Cited by 4 publications

References 23 publications

Predictors of 30-day hospital readmission after mechanical thrombectomy for acute ischemic stroke

Predictors of 30-day hospital readmission after mechanical thrombectomy for acute ischemic stroke

External validation and comparative analysis of the HOSPITAL score and LACE index for predicting readmissions among patients hospitalised with community-acquired pneumonia in Australia

Drivers of variation in 90-day episode payments after mechanical thrombectomy for acute ischemic stroke

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