Hebrew SeniorLife, Institute for Aging Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
J Am Heart Assoc. 2017 Oct 24;6(10):e006696. doi: 10.1161/JAHA.117.006696.
Older patients with aneurysmal subarachnoid hemorrhage (aSAH) are unique, and determinants of post-acute care outcomes are not well elucidated. The primary objective was to identify hospital characteristics associated with 30-day readmission and mortality rates after hospital discharge among older patients with aSAH.
This cohort study used Medicare patients ≥65 years discharged from US hospitals from January 1, 2008, to November 30, 2010, after aSAH. Medicare data were linked to American Hospital Association data to describe characteristics of hospitals treating these patients. Using multivariable logistic regression to adjust for patient characteristics, hospital factors associated with (1) hospital readmission and (2) mortality within 30 days after discharge were identified. A total of 5515 patients ≥65 years underwent surgical repair for aSAH in 431 hospitals. Readmission rate was 17%, and 8.5% of patients died within 30 days of discharge. In multivariable analyses, patients treated in hospitals with lower annualized aSAH volumes were more likely to be readmitted 30 days after discharge (lowest versus highest quintile, 1-2 versus 16-30 cases; adjusted odds ratio, 2.10; 95% confidence interval, 1.56-2.84). Patients treated in hospitals with lower annualized aSAH volumes (lowest versus highest quintile: adjusted odds ratio, 1.52; 95% confidence interval, 1.05-2.19) had a greater likelihood of dying 30 days after discharge.
Older patients with aSAH discharged from hospitals treating lower volumes of such cases are at greater risk of readmission and dying within 30 days. These findings may guide clinician referrals, practice guidelines, and regulatory policies influencing which hospitals should care for older patients with aSAH.
老年蛛网膜下腔出血（aSAH）患者具有独特性，其急性后医疗结局的决定因素尚不清楚。主要目的是确定与老年 aSAH 患者出院后 30 天内再入院和死亡率相关的医院特征。
本队列研究使用了 Medicare 患者，年龄≥65 岁，在 2008 年 1 月 1 日至 2010 年 11 月 30 日期间，在美国医院接受治疗 aSAH 后出院。将 Medicare 数据与美国医院协会数据相关联，以描述治疗这些患者的医院的特征。使用多变量逻辑回归来调整患者特征，确定与（1）医院再入院和（2）出院后 30 天内死亡相关的医院因素。共有 5515 名年龄≥65 岁的患者在 431 家医院接受了 aSAH 的手术修复。再入院率为 17%，出院后 30 天内有 8.5%的患者死亡。在多变量分析中，在每年 aSAH 量较低的医院接受治疗的患者更有可能在出院后 30 天内再次入院（最低五分位数与最高五分位数相比，1-2 例与 16-30 例；调整后的优势比，2.10；95%置信区间，1.56-2.84）。在每年 aSAH 量较低的医院接受治疗的患者（最低五分位数与最高五分位数相比：调整后的优势比，1.52；95%置信区间，1.05-2.19）出院后 30 天内死亡的可能性更大。
从每年处理此类病例量较低的医院出院的老年 aSAH 患者再次入院和 30 天内死亡的风险更高。这些发现可能指导临床医生转诊、实践指南和监管政策，影响哪些医院应该照顾老年 aSAH 患者。
