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30-Day Readmissions After Endovascular Thrombectomy
Study Questions:
What are the incidence, predictors, and causes of 30-day nonelective readmissions after endovascular thrombectomy (EVT)?
Methods:
The investigators used the Nationwide Readmissions Database, years 2013 and 2014, 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.
Results:
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, 4-18 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, 0.91-1.05; p = 0.55).
Conclusions:
The authors concluded that in patients hospitalized with acute ischemic stroke who underwent EVT, 30-day nonelective readmissions were common, occurring in approximately one in eight patients, but were similar to those of patients treated with thrombolysis alone.
Perspective:
This observational study of hospitalizations with acute ischemic stroke who underwent EVT reports that a considerable proportion of patients were readmitted within 30 days. A number of patient characteristics (Medicare or Medicaid payer), clinical comorbidities (diabetes mellitus, coagulopathy), and disease severity/complications (gastrostomy tube placement during the index hospitalization) were associated with 30-day readmission. Of note, the use of adjuvant thrombolytic therapy was not associated with 30-day readmission rates, with no difference in the hazards of readmissions in those who underwent EVT (with or without thrombolysis) versus those who received thrombolysis alone. These data highlight the need for further optimization of secondary preventive measures and use of comprehensive multidisciplinary management during presentation and transitions in care for acute ischemic stroke.
Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Prevention, Aortic Surgery, Cardiac Surgery and Arrhythmias
Keywords: Brain Ischemia, Comorbidity, Diabetes Mellitus, Endovascular Procedures, Fibrinolytic Agents, Gastrostomy, Ischemic Attack, Transient, Medicare, Patient Readmission, Secondary Prevention, Stroke, Thrombectomy, Thrombolytic Therapy, Vascular Diseases
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