Abstract WMP58: Association Of The Lace+ Score With Unplanned 30-day Hospital Readmissions After Stroke

Abstract

The LACE+ score is used to predict unplanned 30-day hospital readmissions, but its association with 30-day readmission after stroke is unknown. We retrospectively analyzed 1,656 consecutive patients presenting with strokes, included in an institutional stroke registry between January 2018 and August 2020. The primary outcome of interest was unplanned 30-day readmission. The 30-day readmission risk was categorized by LACE+ scores: high risk (>81), medium high (59-80) and medium risk (29-58). Kaplan-Meier curve, Log rank test, and multivariable cox regression analysis (with backward elimination) were used to determine whether the LACE+ score was associated with 30-day readmission. The overall incidence of 30-day unplanned readmission was 11.7% (194/1,656). The median LACE+ score was higher in the 30-day readmission group compared to subjects that had no unplanned 30-day readmission (74 (IQ 67-79) vs. 70 (IQ 62-75); p<0.001). On univariate analysis, readmitted patients were older, had a longer index admission length of stay, higher index admission cost, were more likely to be discharged to inpatient rehab, and with higher presence of hypertension, diabetes, history of prior stroke/TIA, and cardiovascular risk factors (p<0.05, each) as compared to non-readmitted group. On Kaplan-Meier analysis, the cumulative 30-day readmission free survival stratified by LACE+ risk category was lowest in the high-risk group and greatest in the medium risk group (Log-rank p<0.001). On multivariable Cox-regression, LACE+ score was independently associated with the unplanned 30-day readmission risk (HR 1.033; 95% CI 1.017-1.050, p<0.001) after adjustment for other variables. This is the first study looking at the association between LACE+ scores and unplanned readmissions in stroke, noting higher LACE+ scores associated with a greater unplanned 30-day readmission after stroke. Future studies on 30-day readmission risks in stroke are needed for quality improvement.