Background: 30-day readmission after hospital discharge is considered an indicator of the quality and efficiency of hospital-level care. Readmission rates are commonly reported for elderly Medicare stroke patients, but there is limited information about rates for younger stroke patients. We used a nationally representative readmission database that includes both insured and uninsured patients to compare 30-day readmission by age and sex subgroups for patients hospitalized with stroke and transient ischemic attack (TIA).
Methods: Hospitalizations for subarachnoid hemorrhage (SAH; ICD-9 430; N=7061), intracerebral hemorrhage (ICH; ICD-9 431; N=17325), ischemic stroke (IS; ICD-9 433, 434, 436; N=212306), and TIA (ICD-9 435; N=67606) were identified for patients aged ≥18y in the 2013 Nationwide Readmissions Database. We fit hierarchical logistic models with hospital random intercepts and adjustment for demographic characteristics, medical history, and clinical factors to assess differences in 30-day readmission by age (18-44, 45-64, 65-84, 85+y) and sex for each condition.
Results: Readmission rates were lowest for SAH (11.1%), followed by TIA (12.2%), IS (12.3%), and ICH (13.8%). Despite modest increases in readmission with age for IS and TIA, rates remained relatively stable across subgroups (table). Readmissions increased from 18-44y to 65-84y for both SAH and ICH but decreased at age 85+y. In adjusted analyses, each 5-year increase in age was associated with a 3% increase in the odds of readmission after ICH (OR 1.03, 95% CI 1.005-1.05) and 2% increase after IS (OR 1.02, 95% CI 1.01-1.03). Women aged ≥65y with IS and aged 45-64y with TIA had lower odds of readmission in risk-adjusted analyses versus men (figure).
Conclusions: Readmission rates varied by age and sex subgroups, but the differences were small. Using 30-day readmissions as an indicator of care, our results suggest stroke and TIA patients receive comparable quality of care regardless of age or sex.