Readmissions and Mortality During the First Year After Stroke—Data From a Population-Based Incidence Study

What is your hospital doing to prevent these avoidable readmissions? ARE THEY EVEN MEASURING READMISSIONS? The answer tells you the competence of the board of directors and whether they should be fired.

Readmissions and Mortality During the First Year After Stroke—Data From a Population-Based Incidence Study

Pedro Abreu^1,2*, Rui Magalhães³, Diana Baptista², Elsa Azevedo^1,2, Maria Carolina Silva³ and Manuel Correia^3,4

• ¹Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal
• ²Department of Clinical Neurosciences and Mental Health, Faculdade de Medicina, Universidade Do Porto, Porto, Portugal
• ³Instituto de Ciências Biomédicas Abel Salazar, Universidade Do Porto, Porto, Portugal
• ⁴Department of Neurology, Hospital Santo António—Centro Hospitalar Universitário Do Porto, Porto, Portugal

Background: After a first-ever-in-a-lifetime stroke (FELS), hospital readmissions are common and associated with increased mortality and morbidity of stroke survivors, thus, raising the overall health burden of stroke. Population-based stroke studies on hospital readmissions are scarce despite it being an important healthcare service quality indicator. We evaluated unplanned readmissions or death during the first year after a FELS and their potential factors, based on a Portuguese community register.

Methods: Data were retrieved from a population-based prospective register undertaken in Northern Portugal (ACIN2) in 2009–2011. Retrospective information about unplanned hospital readmissions and case fatality within 1 year after FELS index hospitalization (FELS-IH) was evaluated. Readmission/death-free survival 1 year after discharge was estimated using the Kaplan–Meyer method. Independent risk factors for readmission/death were identified using Cox proportional hazard models.

Results: Unplanned readmission/death within 1 year occurred in 120 (31.6%) of the 389 hospitalized FELS survivors. In 31.2% and 33.5% of the cases, it occurred after ischemic stroke or intracerebral hemorrhage, respectively. Infections and cerebrovascular and cardiovascular diseases were the main causes of readmission. Of the readmissions, 65.3% and 52.5% were potentially avoidable or stroke related, respectively. The main cause of potentially avoidable readmissions was the continuation/recurrence of the event responsible for the initial admission or a closely related condition (71.2%). Male sex, age, previous and post-stroke functional status, and FELS-IH length of stay were independent factors of readmission/death within 1 year.

Conclusions: Almost one-third of FELS survivors were readmitted/dead 1 year after their FELS-IH. This outcome persisted after the first months after stroke hospitalization in all stroke subtypes. More than half of readmissions were considered potentially avoidable or stroke related.

Introduction

After a first-ever-in-a-lifetime stroke (FELS) or transient ischemic attack (TIA), the use of hospital emergency services or hospital readmissions is common and associated with increased stroke mortality and morbidity, thus, raising the overall health burden of stroke (1). Also, despite some well-characterized limitations (2), readmissions are currently a measure of the hospital's performance and quality of care (3).

Several risk factors for stroke readmissions have been described. However, many meaningful clinical associations may have been ignored since most studies only rely on large administrative or single-hospital databases, particular subtypes of stroke, or readmissions in the first 3 months after stroke (1, 4, 5). This assertion is especially true in Portugal, where, to our knowledge, there are no population-based stroke readmission studies, and therefore, the corresponding information is scarce.

We aimed to study unplanned readmissions or death during the first year after a FELS and to identify their potential factors, based on a Portuguese community register.