Abstract
Background and Aim: Perioperative stroke is a feared and potentially disastrous complication of surgery.
Postdischarge care, specifically hospital readmissions, can significantly impact postsurgical
recovery and provides a useful metric for quality care. Our primary aim was examining
30-day readmissions for patients who had a perioperative stroke undergoing noncardiac
non-neurosurgery. Methods: We analyzed data from the State Inpatient Database, a database of community hospital
discharges, in California between 2008 and2011. Surgical patients undergoing one of
the 10 highest-volume procedures were included; patients less than 18 years old, undergoing
pregnancy-related procedures, or who died in-hospital were excluded. Our dataset covariates
included demographic and clinical variables, comorbidities, and discharge location.
After running an initial bivariate analysis using Chi-square and t-tests and testing
for multicollinearity, logistical models were run to calculate adjusted odds ratios
and confidence intervals for readmission predictors. Results: 30-day readmissions for patients with perioperative stroke (n = 1613) occurred at
a rate of 21.08% (340 patients), compared to 6.29% (63,856 patients) for patients
without perioperative stroke (adjusted OR = 1.40, 95% CI 1.23-1.59, P < .0001). Demographic predictors of 30-day readmissions included male sex and African-American
race. Clinical predictors of 30-day readmissions included several comorbidities (i.e.
liver disease, hypertension), and discharge to a postacute care facility. Key 30-day
readmission diagnoses for perioperative stroke patients included septicemia, stroke,
aspiration pneumonitis, and urinary tract infections. Conclusions: Patients with perioperative stroke have high 30-day readmissions rates. A number
of demographic and clinical factors increase readmission risk in this population.
Further research is warranted to better support patients with perioperative stroke
undergoing care transitions.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Stroke and Cerebrovascular DiseasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Perioperative stroke and associated mortality after noncardiac, nonneurologic surgery.Anesthesiology. 2011; 114: 1289-1296
- Perioperative acute ischemic stroke in noncardiac and nonvascular surgery: incidence, risk factors, and outcomes.Anesthesiology. 2009; 110: 231-238
- Perioperative stroke.New Engl J Med. 2007; 356: 706-713
- Ambulatory Surgery Data From Hospitals and Ambulatory Surgery Centers: United States.National Health Statistics, 2010 (Reports;Number 102)
Prevention CfDCa. Stroke Facts.
- Intermediate-term risk of stroke following cardiac procedures in a nationally representative data set.J Am Heart Assoc. 2017; 6
- Reasons for readmission after carotid endarterectomy.World Neurosurg. 2014; 82: e771-e776
- Readmissions, observation, and the hospital readmissions reduction program.New Engl J Med. 2016; 374: 1543-1551
- Differential risk factors for early and later hospital readmission of older patients.Aging Clin Exp Res. 2005; 17: 322-328
- Neighborhood socioeconomic disadvantage and 30-day rehospitalization: a retrospective cohort study.Ann Intern Med. 2014; 161: 765-774
- Functional health literacy and the risk of hospital admission among Medicare managed care enrollees.Am J Public Health. 2002; 92: 1278-1283
- Thirty-day readmission rates for Medicare beneficiaries by race and site of care.JAMA. 2011; 305: 675-681
- Rethinking thirty-day hospital readmissions: shorter intervals might be better indicators of quality of care.Health Aff (Millwood). 2016; 35: 1867-1875
- Healthcare Cost and Utilization Project (HCUP).Agency for Healthcare Research and Quality, Rockville, MD2008-2011
- A modification of the Elixhauser comorbidity measures into a point system for hospital death using administrative data.Med Care. 2009; 47: 626-633
- Preexisting morbidity as an independent risk factor for perioperative acute thromboembolism syndrome.Arch Surg. 2005; 140 (discussion 1218): 1210-1217
- Impact of perioperative acute ischemic stroke on the outcomes of noncardiac and nonvascular surgery: a single centre prospective study.Can J Surg. 2014; 57: E55-E61
- Incidence and Risk Factors of Perioperative Stroke in Noncardiac, and Nonaortic and Its Major Branches Surgery.J Stroke Cerebrovasc Dis. 2016; 25: 1172-1176
- Racial/ethnic disparities in readmissions in US hospitals: the role of insurance coverage.Inquiry. 2018; 5546958018774180
- Causes and patterns of readmissions in patients with common comorbidities: retrospective cohort study.BMJ. 2013; 347: f7171
- Risk factors for 30-day hospital readmission among general surgery patients.J Am Coll Surg. 2012; 215: 322-330
- A Comparison of All-Cause 7-Day and 30-Day Readmissions, 2014: Statistical Brief #230.Healthcare Cost and Utilization Project (HCUP) Statistical Briefs, RockvilleMD2006
- Stroke risk factors, genetics, and prevention.Circ Res. 2017; 120: 472-495
- Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study.Lancet. 2010; 376: 112-123
- Motor recovery after stroke: a systematic review of the literature.Arch Phys Med Rehabil. 2002; 83: 1629-1637
- Clinical practice. Rehabilitation after stroke.New Engl J Med. 2005; 352: 1677-1684
- The revolving door of rehospitalization from skilled nursing facilities.Health Aff (Millwood). 2010; 29: 57-64
- Abstract TMP9: the Neurovision Pilot Study: non-cardiac surgery carries a significant risk of acute covert stroke.Stroke. 2013; 44
Article info
Publication history
Published online: April 09, 2020
Accepted:
February 25,
2020
Received in revised form:
February 14,
2020
Received:
October 21,
2019
Footnotes
Institution: Department of Neurological Surgery, University of Pittsburgh School of Medicine.
Grant Support: University of Pittsburgh institutional grant.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104792
Copyright
© 2020 Elsevier Inc. All rights reserved.
