Abstract TP198: Risk of 30-day Hospital Readmission: Does Ischemic Stroke Subtype Matter?

Abstract

Background: Stroke patients are at high risk of new diseases. However, as there are differences in risk factors, outcome and treatment for the various ischemic stroke (IS) and transient ischemic attack (TIA) etiologies, there may also be differences in their risk and causes of readmission. We aimed to investigate frequency and causes for 30-day readmission for the different IS subtypes, and estimate each subtypes risk of cause-specific 30-day readmission. Methods: All surviving IS or TIA patients admitted to a large Norwegian Hospital between July 2007 and January 2014 were followed by review of medical records. Main outcome of interest was the first unplanned readmission within 30 days after discharge. Stroke etiology was classified according to the TOAST criteria as large-artery atherosclerosis (LAA), cardioembolism (CE), small vessel occlusion (SVO), stroke of other demonstrated cause (SOC), or stroke of undetermined cause (SUC). Cox regression was performed to assess 30-day readmission risk of all-cause and cause-specific readmission for the different IS subtypes. Results: Of 1890 patients, 10.6 % were readmitted within 30 days (43/245 (17.6%) LAA, 75/614 (12.2%) CE, 12/205 (5.9%) SVO, 6/33 (18.2%) SOC, 65/793 (8.2%) SUC). Most frequent causes were stroke-related events (sequela, progressive stroke and neurological symptoms), infections, recurrent stroke and heart disease, but causes of readmission were unevenly distributed among the different stroke subtypes. Patients with LAA or SOC had significant higher risk of all-cause readmission and recurrent stroke, and patients with SUC had significant lower risk of all-cause readmission. Conclusion: We found significant variations in frequency and causes of 30-day readmission for the different IS subtypes. This approach supports the concept of IS as an polyetiologic disease, with unevenly distributed risk factors and comorbidity between the different etiologies. At the conference, we will also present and discuss predictors for 30-day all-cause readmission.