Background and Purpose: Hospitals are increasingly utilizing 30-day readmission as a quality of care metric. We hypothesize that common infections common during the stroke stay are associated with 30-day readmission (30dRA).
Methods: We conducted a weighted analysis of the federally managed 2013 National Readmission Database to assess the relationship between infection during a stroke hospitalization and 30dRA among ischemic stroke survivors. Ischemic stroke, common infections (defined as sepsis, pneumonia (PNA), and urinary tract infection (UTI)), and comorbidities were identified using ICD-9 diagnosis codes, and IV-tPA or intra-arterial therapy were identified using ICD-9 procedure codes. Survey design logistic regression models were fit to estimate crude and adjusted odds ratios (OR) and 95% confidence intervals (CI) for the association between infections and 30d-RA.
Results: Of the 402042 ischemic stroke patients, 11.2% (n=45247) were readmitted within 30 days, and ~16% (n=7240) had an infection during their index hospitalization. Patients who had a common stroke infection during their stroke admission had a 36% higher odds of being readmitted than patients without any type of infection (OR 1.36, 95%CI 1.30-1.42; Figure 1). The increased odds of readmission remained after adjusting for confounders (OR 1.16, 95%CI 1.11-1.22; Figure 1). Stratifying by age, patients under 65 who had an infection during their stroke admission had an increased adjusted odds of 30d-RA (OR 1.38, 95%CI 1.28-1.49), than those over 65 (OR 1.11, 95%CI 1.06-1.17). The increased odds of readmission remained for those who had sepsis, PNA and a UTI (Figure 1), even after adjusting for covariates of interest.
Conclusions: Using a nationally representative cohort we show that patients who have a common infection during their stroke stay are at increased odds of being readmitted. This presents a unique patients population who may benefit from an earlier post-stroke follow-up.