Rates and reasons for hospital readmission after acute ischemic stroke in a US population-based cohort.
Rates and reasons for hospital readmission after acute ischemic stroke in a US population-based cohort.
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DOI：
10.1371/journal.pone.0289640
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发表时间：
2023
期刊：
影响因子：
3.7
通讯作者：
中科院分区：
文献类型：
--
作者：
中风后再次住院的费用很高，并导致患者预后恶化。我们在一个大型的美国(US)行政数据库中检查了再入院率、再入院时的诊断以及与急性缺血性中风(AIS)再入院相关的危险因素。使用2019年全国再入院数据库，我们将出院的成人AIS(ICD-10-CM I63*)确定为主要诊断。采用威布尔加速失效时间回归进行生存分析，以检验与再入院相关的变量。2019年，285,451名AIS患者中有273,811人在首次住院后存活。其中，60831人(22.2%)在2019年内重新入院。根据Kaplan Meyer分析，首次出院后30天内再住院率为9.7%，一年内再住院率为30.5%。再次住院的最常见原因是中风和中风后后遗症(30天再次住院的25.4%，30-364天再次住院的15.0%)，其次是败血症(30天再次住院的10.3%，30-364天再次住院的9.4%)，以及急性肾功能衰竭(30天再次住院的3.2%，30-364天的再次住院的3.0%)。在调整了多个患者和医院水平的特征后，再次住院风险增加的患者年龄更大(71.6vs.69.8年，p<；0.001)，初始住院时间更长(7.6vs.6.2天，p<；0.001)。他们更经常有可改变的共病，包括血管危险因素(高血压、糖尿病、心房颤动)、抑郁、癫痫和药物滥用。与重新接纳增加相关的社会决定因素包括居住在城市(与农村相比)、生活在收入中值最低的邮政编码地区，以及拥有医疗保险。在P<；0.001，所有因素都达到显著水平。AIS后计划外再入院的比例较高，再次入院的最常见原因是中风复发和中风后后遗症，其次是败血症和急性肾功能衰竭。这些发现表明，减少再入院的努力应侧重于优化二次中风和感染预防，特别是在老年社会弱势患者中。
Hospital readmissions following stroke are costly and lead to worsened patient outcomes. We examined readmissions rates, diagnoses at readmission, and risk factors associated with readmission following acute ischemic stroke (AIS) in a large United States (US) administrative database. Using the 2019 Nationwide Readmissions Database, we identified adults discharged with AIS (ICD-10-CM I63*) as the principal diagnosis. Survival analysis with Weibull accelerated failure time regression was used to examine variables associated with hospital readmission. In 2019, 273,811 of 285,451 AIS patients survived their initial hospitalization. Of these, 60,831 (22.2%) were readmitted within 2019. Based on Kaplan Meyer analysis, readmission rates were 9.7% within 30 days and 30.5% at 1 year following initial discharge. The most common causes of readmissions were stroke and post stroke sequalae (25.4% of 30-day readmissions, 15.0% of readmissions between 30–364 days), followed by sepsis (10.3% of 30-day readmissions, 9.4% of readmissions between 30–364 days), and acute renal failure (3.2% of 30-day readmissions, 3.0% of readmissions between 30–364 days). After adjusting for multiple patient and hospital-level characteristics, patients at increased risk of readmission were older (71.6 vs. 69.8 years, p<0.001) and had longer initial lengths of stay (7.6 vs. 6.2 day, p<0.001). They more often had modifiable comorbidities, including vascular risk factors (hypertension, diabetes, atrial fibrillation), depression, epilepsy, and drug abuse. Social determinants associated with increased readmission included living in an urban (vs. rural) setting, living in zip-codes with the lowest median income, and having Medicare insurance. All factors were significant at p<0.001. Unplanned hospital readmissions following AIS were high, with the most common reasons for readmission being recurrent stroke and post stroke sequalae, followed by sepsis and acute renal failure. These findings suggest that efforts to reduce readmissions should focus on optimizing secondary stroke and infection prevention, particularly among older socially disadvantaged patients.
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