Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, Florida.
Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri.
JACC Cardiovasc Interv. 2018 Dec 10;11(23):2414-2424. doi: 10.1016/j.jcin.2018.09.006.
The authors sought to investigate the incidence, predictors, and causes of 30-day nonelective readmissions after endovascular thrombectomy (EVT).
Randomized trials have demonstrated that EVT improves outcomes in patients with acute ischemic stroke.
The Nationwide Readmissions Database, years 2013 and 2014, was used to identify hospitalizations for a primary diagnosis of acute ischemic stroke during which patients underwent EVT, with or without intravenous thrombolysis. The incidence and reasons of 30-day readmissions were investigated. A hierarchical Cox regression model was used to identify independent predictors of 30-day nonelective readmissions. A propensity score-matched analysis was performed to compare the risk of 30-day nonelective readmissions in those who underwent EVT versus thrombolysis alone.
Among 2,055,365 weighted hospitalizations with acute ischemic stroke and survival to discharge, 10,795 (0.5%) underwent EVT. The 30-day readmission rate was 12.4% within a median of 9 days (interquartile range: 4 to 18 days). Diabetes mellitus, coagulopathy, Medicare or Medicaid insurance, and gastrostomy during the index hospitalization were independent predictors of 30-day readmission, but coadministration of thrombolytics with EVT was not an independent predictor. The most common reasons for readmission were infections (17.2%), cardiac causes (17.0%), and recurrent stroke or transient ischemic attack (14.8%). Compared with thrombolysis alone, the hazard of 30-day readmissions was similar (hazard ratio: 0.98; 95% confidence interval: 0.91 to 1.05; p = 0.55).
In patients hospitalized with acute ischemic stroke who underwent EVT, 30-day nonelective readmissions were common, occurring in approximately 1 in 8 patients, but were similar to those of patients treated with thrombolysis alone. Risk of readmission was associated with certain patient demographics, comorbidities, and complications, but not thrombolysis coadministration. Infections, cardiac causes, and recurrent stroke or transient ischemic attack are the most common reasons for readmission after EVT, emphasizing the need for comprehensive multidisciplinary treatment in the transition to outpatient care.
作者旨在研究血管内血栓切除术（EVT）后 30 天非选择性再入院的发生率、预测因素和原因。
随机试验已经证明 EVT 可以改善急性缺血性脑卒中患者的预后。
使用 2013 年和 2014 年的全国再入院数据库，确定因急性缺血性脑卒中而住院并接受 EVT 治疗的患者，无论是否接受静脉溶栓治疗。调查了 30 天再入院的发生率和原因。使用分层 Cox 回归模型确定 30 天非选择性再入院的独立预测因素。进行倾向评分匹配分析，比较接受 EVT 治疗与单独溶栓治疗的患者 30 天非选择性再入院的风险。
在 2055365 例有存活至出院的急性缺血性脑卒中患者中，有 10795 例（0.5%）接受了 EVT。中位时间为 9 天（四分位距：4 至 18 天）时，30 天再入院率为 12.4%。糖尿病、凝血障碍、医疗保险或医疗补助保险以及指数住院期间行胃造口术是 30 天再入院的独立预测因素，但 EVT 联合溶栓治疗并不是独立的预测因素。再入院的最常见原因是感染（17.2%）、心脏原因（17.0%）和再次发生的脑卒中或短暂性脑缺血发作（14.8%）。与单独溶栓治疗相比，30 天再入院的风险相似（风险比：0.98；95%置信区间：0.91 至 1.05；p=0.55）。
在因急性缺血性脑卒中住院并接受 EVT 治疗的患者中，30 天非选择性再入院很常见，约每 8 例患者中就有 1 例，但与单独接受溶栓治疗的患者相似。再入院的风险与某些患者人口统计学特征、合并症和并发症有关，但与溶栓联合治疗无关。感染、心脏原因和再次发生的脑卒中或短暂性脑缺血发作是 EVT 后再入院的最常见原因，这强调了在过渡到门诊治疗时需要进行全面的多学科治疗。
