Department of Neurology, Chi-Mei Medical Center, Tainan.
Neurology. 2011 Feb 1;76(5):438-43. doi: 10.1212/WNL.0b013e31820a0cd8. Epub 2011 Jan 5.
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.
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.
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.
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.
脑卒中幸存者的再入院率较高，且费用昂贵。本前瞻性队列研究旨在探讨台湾脑卒中住院患者出院后的再入院风险、原因和危险因素。
对 2006 年 8 月 1 日至 2008 年 12 月 31 日期间住院的急性脑卒中患者进行连续监测，通过病历回顾将再入院的主要原因分为脑卒中复发、脑卒中后遗症、其他心血管事件、感染、胃肠道溃疡伴出血和其他原因。使用 Kaplan-Meier 法估计随时间推移的再入院概率，并用 Cox 比例风险模型评估首次再入院的危险因素。
在 2657 例研究患者中，815 例（31%）在出院后 1 年内再次住院。30 天的再入院概率为 10%（95%置信区间为 9%-11%），90 天为 17%（16%-19%），180 天为 24%（22%-26%），360 天为 36%（34%-38%）。再入院的最常见原因是感染（28%）、脑卒中复发（18%）和其他心血管事件（10%）。年龄增长、既往脑卒中/TIA、心房颤动、冠状动脉疾病、住院期间有并发症、住院时间延长和出院时依赖是再入院的独立预测因素。
脑卒中幸存者出院后 1 年内再入院的可能性较高，感染和复发性血管事件是最常见的原因。识别高危亚组可能有助于开展预防干预措施。
