Predictors of 30-day hospital readmission after mechanical thrombectomy for acute ischemic stroke

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  • 1 Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience; and
  • 2 Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
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OBJECTIVE

The 30-day readmission rate is of increasing interest to hospital administrators and physicians, as it is used to evaluate hospital performance and is associated with increased healthcare expenditures. The estimated yearly cost to Medicare of readmissions is $17.4 billion. The Centers for Medicare and Medicaid Services therefore track unplanned 30-day readmissions and institute penalties against hospitals whose readmission rates exceed disease-specific national standards. One of the most important conditions with potential for improvement in cost-effective care is ischemic stroke, which affects 795,000 people in the United States and is a leading cause of death and disability. Recent widespread adoption of mechanical thrombectomy has revolutionized stroke care, requiring reassessment of readmission causes and costs in this population.

METHODS

The authors retrospectively analyzed a prospectively maintained database of stroke patients and identified 561 patients who underwent mechanical thrombectomy between 2010 and 2019 at the authors’ institution. Univariate and multivariate analyses were conducted to identify clinical variables and comorbidities related to 30-day readmissions in this patient population.

RESULTS

Of the 561 patients, 85.6% (n = 480) survived their admission and were discharged from the hospital to home or rehabilitation, and 8.8% (n = 42/480) were readmitted within 30 days. The mean time to readmission was 10.9 ± 7.9 days postdischarge. The most common reasons for readmission were infection (33.3%) and acute cardiac or cerebrovascular events (19% and 20%, respectively). Multivariate analysis showed that hypertension (p = 0.030; OR 2.72) and length of initial hospital stay (p = 0.040; OR 1.032) were significantly correlated with readmission within 30 days, while hemorrhagic conversion (grades 3 and 4) approached significance (p = 0.053; OR 2.23). Other factors, such as unfavorable outcome at discharge, history of coronary artery disease, and discharge destination, did not predict readmission.

CONCLUSIONS

The study data demonstrate that hypertension, length of hospital stay, and hemorrhagic conversion were predictors of 30-day hospital readmission in stroke patients after mechanical thrombectomy. Infection was the most common cause of 30-day readmission, followed by cardiac and cerebrovascular diagnoses. These results therefore may serve to identify patients within the stroke population who require increased surveillance following discharge to reduce complications and unplanned readmissions.

ABBREVIATIONS ACA = anterior cerebral artery; DVT = deep venous thrombosis; ICA = internal cerebral artery; LOS = length of stay; MCA = middle cerebral artery; mRS = modified Rankin Scale; mTICI = modified treatment in cerebral ischemia; NIHSS = National Institutes of Health Stroke Scale; NRD = Nationwide Readmission Database; PCA = posterior cerebral artery; PE = pulmonary embolism; tPA = tissue plasminogen activator; UTI = urinary tract infection.

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Contributor Notes

Correspondence M. Reid Gooch: Thomas Jefferson University Hospital, Philadelphia, PA. reid.gooch@jefferson.edu.

INCLUDE WHEN CITING Published online May 1, 2020; DOI: 10.3171/2020.2.JNS193249.

Disclosures Dr. Tjoumakaris reports being a consultant for Medtronic and MicroVention.

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