Background: Spontaneous intracerebral hemorrhage (sICH) is associated with substantial disability, accounting for considerable resource utilization among stroke survivors. Debate exists about the timing and utilization of tracheostomy (Trach) and percutaneous gastrostomy (PEG) tube placement in sICH patients. We hypothesized that sICH survivors with PEG and/or Trach would have higher odds of 30-day readmission.
Methods: We analyzed the 2013 Nationwide Readmissions Database, a nationally representative sample of hospital discharges. Patients with a primary discharge diagnosis of sICH (ICD-9 code 431) were included in the analysis. Repeat, pediatric, same-day events, head trauma, AVM/fistula, and discharges occurring in December were excluded. Patients who received PEG and/or Trach were identified using published algorithms. We defined readmission as any admission within 30-days of index hospitalization discharge. Odds ratios for 30-day readmission comparing exposed versus unexposed were estimated with adjustment for demographics, risk factors, and concurrent illness. All analyses were performed using survey design variables.
Results: Among the 32,715 sICH index hospitalizations, 3,480 (10.6%) received a PEG and 1806 (5.5%) received a Trach. Overall 4,320 (13.2%) were readmitted within 30 days (PEG 20.5%, trach 18.9%). In the fully adjusted models, sICH patients with PEG had higher odds of readmission (OR 1.43, 95% CI 1.14-1.80), while patients with trach did not (OR 0.77, 95% CI 0.54-1.11). Predictors of readmission among individuals with and without PEG and Trach will be presented.
Conclusions: sICH patients who underwent PEG placement had higher odds of 30-day readmission while patients receiving Trach did not. This finding suggests that heightened post-discharge surveillance of individuals receiving PEG may be warranted.