Readmission after stroke in a hospital-based registry: risk, etiologies, and risk factors

Abstract

Objective: Readmission among stroke survivors is common and costly. This prospective cohort study aimed to explore the readmission risk, causes, and risk factors after discharge from stroke hospitalization in Taiwan.

Methods: Hospitalized patients with acute stroke between August 1, 2006, and December 31, 2008, were prospectively under continuous surveillance on the medical records for any readmission. The main reasons for readmission were categorized by chart review as recurrent stroke, neurologic sequelae of stroke, other cardiovascular event, infection, gastrointestinal ulcer with bleeding, and others. Kaplan-Meier method was used to estimate the probabilities of readmission over time and Cox proportional hazards models were used to evaluate the risk factors for the first readmission.

Results: Of the 2,657 study patients, rehospitalization occurred in 815 (31%) within 1 year after discharge. The probability of readmission at 30 days was 10% (95% confidence interval 9%-11%), at 90 days 17% (16%-19%), at 180 days 24% (22%-26%), and at 360 days 36% (34%-38%). The most frequent reasons for rehospitalization were infection (28%), recurrent stroke (18%), and other cardiovascular event (10%). Increasing age, previous stroke/TIA, atrial fibrillation, coronary artery disease, having complications at the index hospitalization, longer length of stay, and dependency at discharge were the independent predictors for readmission.

Conclusions: Stroke survivors have high likelihood of readmission within 1 year following discharge, with infections and recurrent vascular events being the most common reasons. Identification of high-risk subgroups might foster preventive interventions.