Thirty‐day readmission after spontaneous intracerebral hemorrhage

Abstract

BackgroundIntracerebral hemorrhage (ICH) is the most severe form of stroke, but data on readmission after ICH are sparse. We aimed to determine frequency, causes, and predictors of 30‐day readmission after ICH.Materials and MethodsThis retrospective cohort study includes all spontaneous ICH survivors admitted to the stroke unit at Haukeland University Hospital in Bergen in Norway from July 2007 to December 2013. Patients were followed by review of electronic medical charts, and the first unplanned readmission within 30 days after discharge was used as final outcome. Cox regression analysis was performed to identify predictors of 30‐day readmission.ResultsWe identified 226 patients with spontaneous ICH, 70 (31.0%) of whom died before discharge or were discharged to palliative care. Of the remaining 156 ICH survivors, 28 (18.0%) were readmitted within 30 days. Median time to readmission was 12 days (IQR 4.5 – 18.5). Most patients were readmitted due to infections (N = 13). None of the patients were readmitted with recurrent stroke. Pneumonia and enteral feeding during the index hospitalization were associated with readmission for infections (both p < .01). Age was the only independent predictor of readmission (HR 1.06, 95% CI 1.02 – 1.11, p = .006).ConclusionsAlmost one in five of our spontaneous ICH survivors was readmitted within 30 days, and most readmissions were caused by infections.

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

“…Given that the aforementioned readmission rates are similar to ours, the results of this study serve to confirm those in the literature with a larger, more generalizable sample. Likewise, our median time to readmission of 10 days is consistent with the previously published range (9-10) [2,7].…”

“…Furthermore, characterizing the most common causes of readmission could improve surveillance for complications after discharge that would most likely lead to readmission. A national perspective on 30dRAs after sICH in the United States is lacking, with current data primarily limited to relatively small single institution or single state cohorts [2,7,16,18]. Although a prior study has used the NRD to evaluate 30dRAs among patients with ICH, they included all forms of stroke, did not exclude patients with underlying vascular or neoplastic lesions, and did not provide a detailed analysis of clinically relevant patient characteristics that influenced readmission [33].…”

“…Our rate was likely lower because approximately 42% of our sample was younger than 65 years old. Bjerkreim et al identified 226 sICH survivors from a single institution in Norway and noted a 30dRA rate of 18% [7]. Liotta et al [2] examined 193 ICH patients from a single institution and found an 11% 30dRA rate.…”

“…Stroke was recently added to the list of conditions in which 30dRAs are penalized by the ACA, which prompted numerous studies that analyzed readmission rates for various cerebrovascular insults [1,2,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26]. Despite recent efforts, there remains limited knowledge regarding annual trends and risk factors for 30dRA among patients with spontaneous intracerebral hemorrhage (sICH).…”

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.…”