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

Abstract

Background and objectives Risk of readmissions is an important quality indicator for stroke care. Such information is limited among low- and middle-income countries. We assessed the trends for 28-day readmissions after a stroke in Malaysia from 2008 to 2015 and evaluated the causes and factors associated with readmissions in 2015. Methods Using the national hospital admission records database, we included all stroke patients who were discharged alive between 2008 and 2015 for this secondary data analysis. The risk of readmissions was described in proportion and trends. Reasons were coded according to the International Classification of Diseases, 10th Edition. Multivariable logistic regression was performed to identify factors associated with readmissions. Results Among 151729 patients, 11 to 13% were readmitted within 28 days post-discharge from their stroke events each year. The trend was constant for ischemic stroke but decreasing for hemorrhagic stroke. The leading causes for readmissions were recurrent stroke (32.1%), pneumonia (13.0%) and sepsis (4.8%). The risk of 28-day readmission was higher among those with stroke of hemorrhagic (adjusted odds ratio (AOR): 1.52) and subarachnoid hemorrhage (AOR: 2.56) subtypes, and length of index admission >3 days (AOR: 1.48), but lower among younger age groups of 35–64 (AORs: 0.61–0.75), p values <0.001. Conclusion The risk of 28-day readmission remained constant from 2008 to 2015, where one in eight stroke patients required readmission, mainly attributable to preventable causes. Age, ethnicity, stroke subtypes and duration of the index admission influenced the risk of readmission. Efforts should focus on minimizing potentially preventable admissions, especially among those at higher risk.

Readmission of Stroke Patients and Risk Factors: Literature Review

“…All research uses secondary data from patient medical records. (Ang et al, 2021;Bjerkreim, Khanevski, Glad, et al, 2018;Bjerkreim, Khanevski, Selvik, et al, 2018;Boehme et al, 2018;Chuang et al, 2005;Kilkenny et al, 2020;Swanson & Moger, 2019;Vahidy et al, 2017;Wen et al, 2018b;Zhang et al, 2019a) The results show that the incidence of readmissions for stroke patients ranges from 10%-28% each year, where readmissions for stroke patients can occur 7-30 days after the patient is discharged. The causal factors related to the incidence of readmission in stroke patients can be concluded to be divided into 2 factors, namely factors that cannot be prevented and factors that can be prevented.…”

“…(Bjerkreim, Khanevski, Glad, et al, 2018;Boehme et al, 2018;Miller et al, 2019) The five most common diagnoses or causes for readmission after stroke were recurrent stroke (32.1%), followed by stroke complications such as pneumonia (13.0%), sepsis (4.8%) and urinary tract infection (UTI) ( 2 .9%) and ischemic heart disease (3.7%). (Ang et al, 2021) Based on the results of other studies, it is also stated that a high level of dependence on patients when they are discharged can also be a risk factor for readmissions in patients. Patients with lower functional ability to fulfill their activity daily needs, who still have a high NIHSS score at discharge, may experience higher readmissions < 30 days post discharge.…”

Prediksi Faktor Penyebab Readmisi Pasien Stroke :Studi Kualitatif

“…Hasil penelitian dalam kurun waktu 7 tahun di Taipei, dalam waktu 28 hari setelah pulang ke rumah, 11-13% pasien akan mengalami lagi readmisi setiap tahunnya, terbanyak adalah diagnosis stroke iskemik (Ang et al, 2021). Terdapat beberapa faktor yang menyebabkan readmisi pasien tersebut, dimana usia, jenis kelamin, lama dirawat bukan merupakan faktor yang berpengaruh terhadap readmis (Wu et al, 2007).…”

Stroke Burden in Malaysia

“…Several studies on the outcome of hospital admissions for acute stroke have shown that 36.2% were discharged independent while 53.1% had functional dependence. Between 2008 and 2015, re-admission rates at 28 days post-discharge range from 11 to 13%, usually for stroke recurrence and infection, with a higher risk among those with intracerebral haemorrhage [ 10 , 11 ].…”