Introduction: Readmission for acute ischemic stroke (AIS) is an important quality of care metric, and has been tied to reimbursement penalties. We aimed to describe nationwide readmission for AIS patients, and the potential impact of IV-tPA and Intra Arterial Treatment (IAT) on 30-day readmission.
Methods: We analyzed the 2013 Nationwide Readmission Database, a nationally representative, weighted probability sample of ~ 36 million discharges from short-term hospitals. We used ICD-9 codes to identify patients with diagnosis of AIS (434.x1, 434.x1, 439), and patients receiving IV-tPA (99.1) or IAT (39.74). We excluded repeat, pediatric, and same-day events, and discharges in December. We defined readmissions as any admission within 30-days of index hospitalization discharge. Using published methods, we classified events as planned or unplanned, and identified readmissions attributable to potentially preventable ambulatory care-sensitive conditions. Logistic regression, using survey design variables, was performed to report nationally-weighted estimates of odds ratios (OR) and 95% CIs for factors associated with readmission.
Results: A total of 319,317 index cases were identified with a primary diagnosis of AIS. Figure 1 illustrates the overall and therapy specific proportions for 30-day readmissions. Overall 12.1% (95% CI: 11.9 -12.3) of AIS patients were readmitted during 30-day post index hospitalization discharge. After adjustment, both IV-tPA and IAT were significantly associated with lower odds of 30-day readmission. For patients receiving either IV-tPA or undergoing IAT, the OR for 30-day readmission was 0.71 (CI: 0.66 - 0.77). Subgroup analyses for patients older than 65, and reasons for readmission will be presented.
Conclusion: Recanalization therapy for AIS is associated with 23-34% lower odds of readmission. Analyses are limited by lack of survival data; however, thrombolysis has not shown to increase mortality in clinical trials.