Abstract TP283: Nationwide Trends of Thirty Day Readmissions : Carotid Versus Vertebral Artery Dissections

Abstract

Introduction: Carotid and vertebral artery dissection significantly increases risk of ischemic stroke. Due to variability in treatment for stroke prevention and different mechanisms of dissection-related stroke, it is important to understand differences in 30 day unplanned readmission rates (30RR) and related causes of readmission in this population. Methods: We used the year 2014 NRD (Nationwide Readmission Database) which is designed to generate national estimates of readmission. The patients with carotid and vertebral dissections were identified by primary discharge diagnosis with ICD9-CM code 443.21 and 443.24. All causes of 30RR were calculated for patients admitted between January and November 2014 by excluding elective readmissions. Differences in readmission rates due to different causes were examined with univariate analysis. Results: The NRD contained 1164 (Weighted N = 2550) admissions due to carotid dissection (CD), and 1244 (Weighted N = 2644) admissions due to vertebral dissections (VD). There was no significant difference for comparing average age of readmitted patients [57.5 years (CD) Vs. 56.74 years (VD), p=0.49]. 30RR for CD (15.45%) was higher compared to VD (13.43%) (p=0.037). Major cause specific 30RR in CD and VD included acute cerebrovascular event (4.54% vs 6.43%, p=0.004), sepsis (0.07% vs 0.06%, p= 0.78) and TIA (0.07% vs 0.04%, p=0.09). Conclusion: The 30RR for acute cerebrovascular events was elevated in carotid and vertebral dissection patients in a nationally representative readmission database. Although the 30RR is higher for carotid compared to vertebral artery dissection, acute cerebrovascular event related readmissions remains significantly high in vertebral artery dissection patients. Further investigations are necessary to explore these differences, including analysis of the various treatments and the specific anatomic features of these dissections.