Nationwide Estimates of 30-Day Readmission in Patients With Ischemic Stroke

Abstract

Background and Purpose— Readmission within 30 days of hospital discharge for ischemic stroke is an important quality of care metric. We aimed to provide nationwide estimates of 30-day readmission in the United States, describe important reasons for readmission, and sought to explore factors associated with 30-day readmission, particularly the association with recanalization therapy. Methods— We conducted a weighted analysis of the 2013 Nationwide Readmission Database to represent all US hospitalizations. Adult patients with acute ischemic stroke including those who received intravenous tissue-type plasminogen activator and intra-arterial therapy were identified using International Classification of Diseases -Ninth Revision codes. Readmissions were defined as any readmission during the 30-day post-index hospitalization discharge period for the eligible patient population. Proportions and 95% confidence intervals for overall 30-day readmissions and for unplanned and potentially preventable readmissions are reported. Survey design logistic regression models were fit for determining crude and adjusted odds ratios and 95% confidence interval for association between recanalization therapy and 30-day readmission. Results— Of the 319 317 patients with acute ischemic stroke, 12.1% (95% confidence interval, 11.9–12.3) were readmitted. Of these, 89.6% were unplanned and 12.9% were potentially preventable. More than 20% of all readmissions were attributable to acute cerebrovascular disease. Readmitted patients were older and had a higher comorbidity burden. After controlling for age, sex, insurance status, and comorbidities, patients who underwent recanalization therapy had significantly lower odds of 30-day readmission (odds ratio, 0.82; 95% confidence interval, 0.77–0.89). Conclusions— Up to 12% of patients with ischemic stroke get readmitted within 30 days post-discharge period, and recanalization therapy is associated with 11% to 23% lower odds of 30-day readmission.