Divisions of Cerebrovascular Disease, Critical Care, and Neurotrauma, Thomas Jefferson University, Philadelphia, PA, USA.
Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
Neurocrit Care. 2018 Dec;29(3):336-343. doi: 10.1007/s12028-018-0557-1.
To estimate rates of all-cause and potentially preventable readmissions up to 90 days after discharge for aneurysmal subarachnoid hemorrhage (SAH) and medical comorbidities associated with readmissions BACKGROUND: Readmission rate is a common metric linked to compensation and used as a proxy to quality of care. Prior studies in SAH have reported 30-day readmission rates of 7-17% with a higher readmission risk among those with the higher SAH severity, ≥ 3 comorbidities, and non-home discharge. Intermediate-term rates, up to 90-days, and the proportion of these readmissions that are potentially preventable are unknown. Furthermore, the specific medical comorbidities associated with readmissions are unknown.
Index SAH admissions were identified from the 2013 Nationwide Readmissions Database. All-cause readmissions were defined as any readmission during the 30-, 60-, and 90-day post-discharge period. Potentially preventable readmissions were identified using Prevention Quality Indicators developed by the US Agency for Healthcare Research and Quality. Unadjusted and adjusted Poisson models were used to identify factors associated with increased readmission rates.
Out of 9987 index admissions for SAH, 7949 (79%) survived to discharge. The percentage of 30-, 60-, and 90-day all-cause readmissions were 7.8, 16.6, and 26%, respectively. Up to 14% of readmissions in the first 30 days were considered potentially preventable and acute conditions (dehydration, bacterial pneumonia, and urinary tract infections) accounted for over half, whereas acute cerebrovascular disease was the most common cause for neurological return. In multivariable analysis, significant predictors of a higher readmission rate included diabetes (rate ratio [RR] 1.09, 95% confidence interval [CI] 1.03-1.15), congestive heart failure (RR 1.09, 1.003-1.18), and renal impairment (RR 1.35, 1.13-1.61). Only discharge home was associated with a lower readmission rate (RR 0.89, 0.85-0.93).
SAH has a 30-day readmission rate of 7.8% which continues to rise into the intermediate-term. A low but constant proportion of readmissions are potentially preventable. Several chronic medical comorbidities were associated with readmissions. Prospective studies are warranted to clarify causal relationships.
评估颅内动脉瘤性蛛网膜下腔出血（SAH）患者出院后 90 天内全因和潜在可预防再入院率，以及与再入院相关的医疗合并症。背景：再入院率是与赔偿相关的常用指标，常被用作护理质量的替代指标。先前关于 SAH 的研究报告称，30 天再入院率为 7-17%，SAH 严重程度较高、合并症≥3 种、非居家出院的患者再入院风险更高。目前尚不清楚 90 天内的中期再入院率以及这些再入院中潜在可预防的比例。此外，与再入院相关的具体医疗合并症也不清楚。方法：从 2013 年全国再入院数据库中确定 SAH 索引入院。全因再入院定义为出院后 30、60 和 90 天内的任何再入院。使用美国医疗保健研究与质量局开发的预防质量指标确定潜在可预防的再入院。采用未调整和调整后的泊松模型确定与再入院率增加相关的因素。结果：在 9987 例颅内动脉瘤性蛛网膜下腔出血索引入院中，7949 例（79%）存活至出院。30 天、60 天和 90 天全因再入院率分别为 7.8%、16.6%和 26%。在最初 30 天内，约有 14%的再入院可被认为是潜在可预防的，急性疾病（脱水、细菌性肺炎和尿路感染）占了一半以上，而急性脑血管病是神经科再入院的最常见原因。多变量分析显示，更高的再入院率的显著预测因素包括糖尿病（比率比 [RR] 1.09，95%置信区间 [CI] 1.03-1.15）、充血性心力衰竭（RR 1.09，1.003-1.18）和肾功能损害（RR 1.35，1.13-1.61）。只有居家出院与较低的再入院率相关（RR 0.89，0.85-0.93）。结论：颅内动脉瘤性蛛网膜下腔出血的 30 天再入院率为 7.8%，且在中期持续上升。潜在可预防的再入院比例虽然较低，但保持稳定。一些慢性合并症与再入院相关。需要前瞻性研究来明确因果关系。
