Rates and reasons for hospital readmission after acute ischemic stroke in a US population-based cohort

Hospital readmissions following stroke are costly and lead to worsened patient outcomes. We examined readmissions rates, diagnoses at readmission, and risk factors associated with readmission following acute ischemic stroke (AIS) in a large United States (US) administrative database. Using the 2019...

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Autores principales: Zhou, Lily W., Lansberg, Maarten G., de Havenon, Adam
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10399731/
https://www.ncbi.nlm.nih.gov/pubmed/37535655
http://dx.doi.org/10.1371/journal.pone.0289640
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author Zhou, Lily W.
Lansberg, Maarten G.
de Havenon, Adam
author_facet Zhou, Lily W.
Lansberg, Maarten G.
de Havenon, Adam
author_sort Zhou, Lily W.
collection PubMed
description Hospital readmissions following stroke are costly and lead to worsened patient outcomes. We examined readmissions rates, diagnoses at readmission, and risk factors associated with readmission following acute ischemic stroke (AIS) in a large United States (US) administrative database. Using the 2019 Nationwide Readmissions Database, we identified adults discharged with AIS (ICD-10-CM I63*) as the principal diagnosis. Survival analysis with Weibull accelerated failure time regression was used to examine variables associated with hospital readmission. In 2019, 273,811 of 285,451 AIS patients survived their initial hospitalization. Of these, 60,831 (22.2%) were readmitted within 2019. Based on Kaplan Meyer analysis, readmission rates were 9.7% within 30 days and 30.5% at 1 year following initial discharge. The most common causes of readmissions were stroke and post stroke sequalae (25.4% of 30-day readmissions, 15.0% of readmissions between 30–364 days), followed by sepsis (10.3% of 30-day readmissions, 9.4% of readmissions between 30–364 days), and acute renal failure (3.2% of 30-day readmissions, 3.0% of readmissions between 30–364 days). After adjusting for multiple patient and hospital-level characteristics, patients at increased risk of readmission were older (71.6 vs. 69.8 years, p<0.001) and had longer initial lengths of stay (7.6 vs. 6.2 day, p<0.001). They more often had modifiable comorbidities, including vascular risk factors (hypertension, diabetes, atrial fibrillation), depression, epilepsy, and drug abuse. Social determinants associated with increased readmission included living in an urban (vs. rural) setting, living in zip-codes with the lowest median income, and having Medicare insurance. All factors were significant at p<0.001. Unplanned hospital readmissions following AIS were high, with the most common reasons for readmission being recurrent stroke and post stroke sequalae, followed by sepsis and acute renal failure. These findings suggest that efforts to reduce readmissions should focus on optimizing secondary stroke and infection prevention, particularly among older socially disadvantaged patients.
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spelling pubmed-103997312023-08-04 Rates and reasons for hospital readmission after acute ischemic stroke in a US population-based cohort Zhou, Lily W. Lansberg, Maarten G. de Havenon, Adam PLoS One Research Article Hospital readmissions following stroke are costly and lead to worsened patient outcomes. We examined readmissions rates, diagnoses at readmission, and risk factors associated with readmission following acute ischemic stroke (AIS) in a large United States (US) administrative database. Using the 2019 Nationwide Readmissions Database, we identified adults discharged with AIS (ICD-10-CM I63*) as the principal diagnosis. Survival analysis with Weibull accelerated failure time regression was used to examine variables associated with hospital readmission. In 2019, 273,811 of 285,451 AIS patients survived their initial hospitalization. Of these, 60,831 (22.2%) were readmitted within 2019. Based on Kaplan Meyer analysis, readmission rates were 9.7% within 30 days and 30.5% at 1 year following initial discharge. The most common causes of readmissions were stroke and post stroke sequalae (25.4% of 30-day readmissions, 15.0% of readmissions between 30–364 days), followed by sepsis (10.3% of 30-day readmissions, 9.4% of readmissions between 30–364 days), and acute renal failure (3.2% of 30-day readmissions, 3.0% of readmissions between 30–364 days). After adjusting for multiple patient and hospital-level characteristics, patients at increased risk of readmission were older (71.6 vs. 69.8 years, p<0.001) and had longer initial lengths of stay (7.6 vs. 6.2 day, p<0.001). They more often had modifiable comorbidities, including vascular risk factors (hypertension, diabetes, atrial fibrillation), depression, epilepsy, and drug abuse. Social determinants associated with increased readmission included living in an urban (vs. rural) setting, living in zip-codes with the lowest median income, and having Medicare insurance. All factors were significant at p<0.001. Unplanned hospital readmissions following AIS were high, with the most common reasons for readmission being recurrent stroke and post stroke sequalae, followed by sepsis and acute renal failure. These findings suggest that efforts to reduce readmissions should focus on optimizing secondary stroke and infection prevention, particularly among older socially disadvantaged patients. Public Library of Science 2023-08-03 /pmc/articles/PMC10399731/ /pubmed/37535655 http://dx.doi.org/10.1371/journal.pone.0289640 Text en © 2023 Zhou et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Zhou, Lily W.
Lansberg, Maarten G.
de Havenon, Adam
Rates and reasons for hospital readmission after acute ischemic stroke in a US population-based cohort
title Rates and reasons for hospital readmission after acute ischemic stroke in a US population-based cohort
title_full Rates and reasons for hospital readmission after acute ischemic stroke in a US population-based cohort
title_fullStr Rates and reasons for hospital readmission after acute ischemic stroke in a US population-based cohort
title_full_unstemmed Rates and reasons for hospital readmission after acute ischemic stroke in a US population-based cohort
title_short Rates and reasons for hospital readmission after acute ischemic stroke in a US population-based cohort
title_sort rates and reasons for hospital readmission after acute ischemic stroke in a us population-based cohort
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10399731/
https://www.ncbi.nlm.nih.gov/pubmed/37535655
http://dx.doi.org/10.1371/journal.pone.0289640
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