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Preventable Readmissions and Predictors of Readmission After Subarachnoid Hemorrhage

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Abstract

Objective

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.

Methods

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.

Results

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).

Conclusions

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.

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Acknowledgements

This work was supported in part through the computational resources and staff expertise provided by Scientific Computing at the Icahn School of Medicine at Mount Sinai.

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Author notes

  1. John W. Liang and Laura Cifrese are co-first authors.

Authors and Affiliations

  1. Divisions of Cerebrovascular Disease, Critical Care, and Neurotrauma, Thomas Jefferson University, Philadelphia, PA, USA

    John W. Liang & Syed O. Shah

  2. Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA

    John W. Liang & Laura Cifrese

  3. Department of Neurology, Mount Sinai Downtown, New York, NY, USA

    John W. Liang & Lili Velickovic Ostojic

  4. Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Mandip S. Dhamoon

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  1. John W. Liang
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  2. Laura Cifrese
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  4. Syed O. Shah
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Contributions

JWL and SOS were involved in study concept and design. JWL and LC drafted the manuscript. JWL, LC, LVO and MD helped in acquisition, analysis, or interpretation of data. MD performed statistical analysis. SOS and MD contributed to critical revision of the manuscript.

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Correspondence to John W. Liang.

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The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Liang, J.W., Cifrese, L., Ostojic, L.V. et al. Preventable Readmissions and Predictors of Readmission After Subarachnoid Hemorrhage. Neurocrit Care 29, 336–343 (2018). https://doi.org/10.1007/s12028-018-0557-1

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  • DOI: https://doi.org/10.1007/s12028-018-0557-1

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