Lengthy Index Stay for Stroke May Predict Readmission

HONOLULU – The only factor associated with readmission within 30 days among patients with stroke or cerebrovascular disease was an index hospitalization that lasted more than 10 days, results from a large, single-center analysis found.

"One proposed mechanism to reduce 30-day readmissions has been early post-discharge outpatient follow-up," researchers led by Dr. Fadi Nahab wrote in a poster presented at the annual meeting of the American Academy of Neurology. "In our study population, only 5% of patients had an outpatient follow-up recommended within 1 week. Scheduling follow-up [within 1 week] in a specialty stroke clinic prior to discharge should be evaluated as a potential approach to reduce 30-day readmissions among patients discharged with a diagnosis of stroke or cerebrovascular disease."

Dr. Nahab of the department of neurology at Emory University, Atlanta, and his associates used University HealthSystem Consortium records to identify 2,706 patients discharged from Emory University Hospital with a diagnosis of stroke or cerebrovascular disease between Jan. 1, 2007, and Dec. 31, 2009. They excluded patients readmitted within 30 days for rehabilitation, chemotherapy, radiation therapy, dialysis, and delivery.

The study population included patients with a mean age of 62 years and most were white (55%) or black (33%). Their diagnoses at discharge were ischemic stroke (35%), subarachnoid hemorrhage (25%), intracerebral hemorrhage (16%), transient ischemic attack (7%), or other cerebrovascular diseases (17%).

Of the 2,706 patients studied, 174 had 178 readmissions within 30 days, for a rate of 7%. The top three discharging providers were neurologists (40%), neurosurgeons (33%), and vascular surgeons (16%).

Multivariate analysis revealed that an index hospital stay of more than 10 days was the only significant factor associated with readmission within 30 days (odds ratio of 2.34 when compared with an index hospital stay of less than 5 days). Age, gender, race, primary diagnosis, the specialty of the discharging clinicians, and the year of discharge were not significant predictors.

"Length of stay is often considered a representation of disease severity and our results add support to the previously mixed data showing that a prolonged hospital length of stay is associated with higher readmission rates among patients with stroke and cerebrovascular disease," Dr. Nahab said in an interview after the meeting.

Among nonsurgical specialties, the researchers observed a trend toward lower 30-day readmission rates by neurologists than by physicians from other specialties: 6% among neurologists, compared with 9% among internists and cardiologists.

The researchers also found that initial follow-up was recommended within 30 days for 57% of patients and within one week for 5% of patients. However, only 14% of patients had an outpatient follow-up appointment scheduled prior to discharge. In the study, a lack of early outpatient follow-up represented the most common contributor to unplanned avoidable readmissions.

"While identifying patient characteristics that predict the likelihood of a readmission may help providers recognize patients who are at greatest risk for readmission, the significant heterogeneity among prior studies highlights the complexity of factors that contribute to readmission among stroke patients," Dr. Nahab said. "If we are to intervene and reduce readmissions, early (less than 1 week) outpatient follow-up scheduled prior to hospital discharge needs to be studied as one possible answer."

Dr. Nahab said that he had no relevant financial disclosures to make.

HONOLULU – The only factor associated with readmission within 30 days among patients with stroke or cerebrovascular disease was an index hospitalization that lasted more than 10 days, results from a large, single-center analysis found.

"One proposed mechanism to reduce 30-day readmissions has been early post-discharge outpatient follow-up," researchers led by Dr. Fadi Nahab wrote in a poster presented at the annual meeting of the American Academy of Neurology. "In our study population, only 5% of patients had an outpatient follow-up recommended within 1 week. Scheduling follow-up [within 1 week] in a specialty stroke clinic prior to discharge should be evaluated as a potential approach to reduce 30-day readmissions among patients discharged with a diagnosis of stroke or cerebrovascular disease."

Dr. Nahab of the department of neurology at Emory University, Atlanta, and his associates used University HealthSystem Consortium records to identify 2,706 patients discharged from Emory University Hospital with a diagnosis of stroke or cerebrovascular disease between Jan. 1, 2007, and Dec. 31, 2009. They excluded patients readmitted within 30 days for rehabilitation, chemotherapy, radiation therapy, dialysis, and delivery.

The study population included patients with a mean age of 62 years and most were white (55%) or black (33%). Their diagnoses at discharge were ischemic stroke (35%), subarachnoid hemorrhage (25%), intracerebral hemorrhage (16%), transient ischemic attack (7%), or other cerebrovascular diseases (17%).

Of the 2,706 patients studied, 174 had 178 readmissions within 30 days, for a rate of 7%. The top three discharging providers were neurologists (40%), neurosurgeons (33%), and vascular surgeons (16%).

Multivariate analysis revealed that an index hospital stay of more than 10 days was the only significant factor associated with readmission within 30 days (odds ratio of 2.34 when compared with an index hospital stay of less than 5 days). Age, gender, race, primary diagnosis, the specialty of the discharging clinicians, and the year of discharge were not significant predictors.

"Length of stay is often considered a representation of disease severity and our results add support to the previously mixed data showing that a prolonged hospital length of stay is associated with higher readmission rates among patients with stroke and cerebrovascular disease," Dr. Nahab said in an interview after the meeting.

Among nonsurgical specialties, the researchers observed a trend toward lower 30-day readmission rates by neurologists than by physicians from other specialties: 6% among neurologists, compared with 9% among internists and cardiologists.

The researchers also found that initial follow-up was recommended within 30 days for 57% of patients and within one week for 5% of patients. However, only 14% of patients had an outpatient follow-up appointment scheduled prior to discharge. In the study, a lack of early outpatient follow-up represented the most common contributor to unplanned avoidable readmissions.

"While identifying patient characteristics that predict the likelihood of a readmission may help providers recognize patients who are at greatest risk for readmission, the significant heterogeneity among prior studies highlights the complexity of factors that contribute to readmission among stroke patients," Dr. Nahab said. "If we are to intervene and reduce readmissions, early (less than 1 week) outpatient follow-up scheduled prior to hospital discharge needs to be studied as one possible answer."

Dr. Nahab said that he had no relevant financial disclosures to make.

HONOLULU – The only factor associated with readmission within 30 days among patients with stroke or cerebrovascular disease was an index hospitalization that lasted more than 10 days, results from a large, single-center analysis found.

"One proposed mechanism to reduce 30-day readmissions has been early post-discharge outpatient follow-up," researchers led by Dr. Fadi Nahab wrote in a poster presented at the annual meeting of the American Academy of Neurology. "In our study population, only 5% of patients had an outpatient follow-up recommended within 1 week. Scheduling follow-up [within 1 week] in a specialty stroke clinic prior to discharge should be evaluated as a potential approach to reduce 30-day readmissions among patients discharged with a diagnosis of stroke or cerebrovascular disease."

Dr. Nahab of the department of neurology at Emory University, Atlanta, and his associates used University HealthSystem Consortium records to identify 2,706 patients discharged from Emory University Hospital with a diagnosis of stroke or cerebrovascular disease between Jan. 1, 2007, and Dec. 31, 2009. They excluded patients readmitted within 30 days for rehabilitation, chemotherapy, radiation therapy, dialysis, and delivery.

The study population included patients with a mean age of 62 years and most were white (55%) or black (33%). Their diagnoses at discharge were ischemic stroke (35%), subarachnoid hemorrhage (25%), intracerebral hemorrhage (16%), transient ischemic attack (7%), or other cerebrovascular diseases (17%).

Of the 2,706 patients studied, 174 had 178 readmissions within 30 days, for a rate of 7%. The top three discharging providers were neurologists (40%), neurosurgeons (33%), and vascular surgeons (16%).

Multivariate analysis revealed that an index hospital stay of more than 10 days was the only significant factor associated with readmission within 30 days (odds ratio of 2.34 when compared with an index hospital stay of less than 5 days). Age, gender, race, primary diagnosis, the specialty of the discharging clinicians, and the year of discharge were not significant predictors.

"Length of stay is often considered a representation of disease severity and our results add support to the previously mixed data showing that a prolonged hospital length of stay is associated with higher readmission rates among patients with stroke and cerebrovascular disease," Dr. Nahab said in an interview after the meeting.

Among nonsurgical specialties, the researchers observed a trend toward lower 30-day readmission rates by neurologists than by physicians from other specialties: 6% among neurologists, compared with 9% among internists and cardiologists.

The researchers also found that initial follow-up was recommended within 30 days for 57% of patients and within one week for 5% of patients. However, only 14% of patients had an outpatient follow-up appointment scheduled prior to discharge. In the study, a lack of early outpatient follow-up represented the most common contributor to unplanned avoidable readmissions.

"While identifying patient characteristics that predict the likelihood of a readmission may help providers recognize patients who are at greatest risk for readmission, the significant heterogeneity among prior studies highlights the complexity of factors that contribute to readmission among stroke patients," Dr. Nahab said. "If we are to intervene and reduce readmissions, early (less than 1 week) outpatient follow-up scheduled prior to hospital discharge needs to be studied as one possible answer."

Dr. Nahab said that he had no relevant financial disclosures to make.