Infections Increase the Risk of 30-Day Readmissions Among Stroke Survivors

Boehme, Amelia K; Kulick, Erin R.; Canning, Michelle; Alvord, Trevor; Khaksari, Bijan; Omran, Setareh Salehi; Willey, Joshua Z.; Elkind, Mitchell S.V.

doi:10.1161/strokeaha.118.022837

Cited by 26 publications

(35 citation statements)

References 26 publications

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“…Since infectious etiologies were the second most common reason for readmission in our cohort, it was not surprising that those who developed a HAI during the index hospitalization were more likely to be readmitted. Indeed, similar results have been reported in ischemic stroke [35]. The development of a HAI could have reflected an underlying immunocompromised state or a longer index hospitalization.…”

Section: Discussionsupporting

confidence: 80%

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

Hoffman

Furst

Jalal

et al. 2020

Heliyon

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Objective: 30-day readmission rate is a quality metric often employed to represent hospital and provider performance. Currently, little is known regarding 30-day readmissions (30dRA) following spontaneous intracerebral hemorrhage (sICH). The purpose of this study was to use a national database to identify risk factors and trends in 30dRAs following sICH. Patients and methods: 64,909 cases with a primary diagnosis of sICH were identified within the Nationwide Readmission Database (NRD) from 2010 through 2014. Charlson Comorbidity Index (CCI) was used to adjust for the severity of each patient's comorbidities. A binary logistic regression model was constructed to identify predictors of 30-day readmission. Cochran-Mantel-Haenszel test was used to generate a pooled odd ratio (OR) describing the likelihood of experiencing a 30dRA according to year. Results: The 30dRA rate following sICH decreased from 13.9% in 2010 to 12.5% in 2014 (pooled OR ¼ 0.90, 95% CI 0.87-0.94). Cerebrovascular and cardiovascular etiologies accounted for the greatest number of admissions (36.1%). Sodium abnormality, healthcare-associated infection, gastrostomy, venous thromboembolism, and ischemic stroke during the index admission were associated with 30-day readmission. Furthermore, patients who underwent ventriculostomy (OR ¼ 1.20, 95% CI 1.03-1.38) and craniotomy (OR ¼ 1.20, 95% CI 1.09-1.31) were more likely to be readmitted within 30 days. Hospital volume, hospital teaching status, mechanical ventilation, and tracheostomy did not affect 30dRAs. Median readmission costs increased from $9,875 in 2012 to $11,028 in 2014 (p ¼ 0.040). Conclusion: The overall U.S. 30dRA rate after sICH from 2010 to 2014 was 12.9% and decreased slightly during this time period, but associated costs increased. Prospective studies are required to confirm the risk factors described in this study and to identify methods for preventing readmissions.

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Section: Discussionsupporting

confidence: 80%

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

Hoffman

Furst

Jalal

et al. 2020

Heliyon

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“…In a recent study from the 2013 National Readmission Database in the US, 29% had an infection during the index admission, and the odds of an unplanned 30-day readmission was 23% higher in patients with infections. 228 The study also found that only 14% of the stroke patients that were readmitted for an infection did not have an infection during the index admission. 228 We found that complications were more frequent in patients readmitted early.…”

Section: Risk Factors For Hospital Readmission After Ischemic Stroke mentioning

confidence: 86%

“…228 The study also found that only 14% of the stroke patients that were readmitted for an infection did not have an infection during the index admission. 228 We found that complications were more frequent in patients readmitted early. A likely explanation is that patients with complications have more severe strokes which increases the risk of readmission, and that complications have an adverse impact on the functional outcome.…”

Section: Risk Factors For Hospital Readmission After Ischemic Stroke mentioning

confidence: 86%

Five-year readmission and mortality differ by ischemic stroke subtype

Bjerkreim

Khanevski

Thomassen

et al. 2019

Journal of the Neurological Sciences

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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 largeartery 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.

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“…In our study, one-fifth (21.7%) of acute ischemic stroke (AIS) patients treated with IV-tPA were readmitted within 90 days of initial hospitalization, of which 20.6% were readmissions to non-index hospitals. Prior ischemic stroke studies have reported 7-12% 30-day readmission rates [12][13][14][15][16][17]. A large ischemic stroke hospital registry documented readmission rates of 10% at 30 days, 17% at 90 days, 24% at 180 days, and 36% at 360 days [18].…”

Section: Discussionmentioning

confidence: 99%

“…The most common cause for readmission within 30 days not related to IV-tPA is acute cerebrovascular disease, accounting for nearly 20% of readmitted patients [12,17]. Previous nationwide studies in stroke suggest that infection is the second leading cause of 30-day readmission (10-15% of patients) [12,14]. Our results demonstrate a similar pattern, with cerebral artery occlusion (8.73%), septicemia (5.83%), and carotid artery occlusion (5.22%) as the most common causes for readmission within 90 days.…”

Section: Discussionmentioning

confidence: 99%

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

Shkirkova¹,

Connor²,

Hodis³

et al. 2020

Cureus

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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.

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Infections Increase the Risk of 30-Day Readmissions Among Stroke Survivors

Cited by 26 publications

References 26 publications

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

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

Five-year readmission and mortality differ by ischemic stroke subtype

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

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