Abstract TP282: High Mortality Among 30-Day Readmission After Stroke: Predictors and Etiologies of Readmission

Abstract

Background: Although risk factors for readmission have been reported, the mortality risk is unclear. We sought to evaluate etiologies and predictors of 30-day readmission and determine the associated mortality risk. Methods: This is a retrospective case-control study evaluating stroke patients (hemorrhagic, ischemic or TIA) from January 2013-December 2014 and those readmitted within 30 days after index event; including 135 readmitted patients and 1,664 controls. Readmission for hospice or elective surgery were excluded. Socio-demographics, clinical variables and potential risk factors were assessed using chi-square test of proportions and multi variable logistic regression was performed to identify independent predictors of 30-day stroke readmission. Index mortality was compared to readmission mortality and odds associated with readmission was identified. Results: Overall, 67% of index stroke admissions were ischemic, 19% hemorrhagic, and 14% TIA. The 30-day readmission rate was 7.3%. The most common etiologies for readmission were infection (30%), recurrent stroke (17%), and cardiac complications (14%). Recurrent strokes presented earliest (p=0.047) and had a shorter index admission length of stay (p=0.02.) Risk factors for 30-day readmission included age > 75 ( p=0.04 ), lack of spouse ( p=0.05 ), living in a facility prior to index stroke ( p=0.033 ), history of prior stroke ( p=0.02 ), diabetes ( p=.018 ), CHF ( p=<.0001 ), atherosclerosis ( p=<0.01 ), admission to non-stroke unit ( p=0.02 ), non-home discharge status ( p<0.01 ), and index admission to a non-neurology service was an independent predictor of 30-day readmission (p=<0.01). The overall mortality associated with 30-day readmission after stroke was higher as compared to index admission (37.3% vs 13.3% p =<0.01) (OR 3.7 95%CI 2.5-5.3) and was not influenced by recurrent stroke (p=0.37) . Conclusion: In our study, infection and recurrent stroke were most common causes and index admission to a non-neurology service was the strongest readmission predictor. The overall mortality is high and not influenced by recurrent stroke. Identifying high risk patients, ensuring appropriate level of service and early outpatient follow-up may help reduce 30-day readmission and risk of mortality.