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Prevalence, causes and risk factors of hospital readmissions after acute stroke and transient ischemic attack: a systematic review and meta-analysis

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Abstract

Acute stroke and transient ischemic attack (TIA) is a great burden not only during hospitalization but also after hospital discharge. The objective of this meta-analysis was to evaluate the hospital readmissions, causes and risk factors after survival of acute stroke and TIA. Pubmed, Web of Science, Cochrane Library, OVID and EMBASE databases were searched to identify studies reporting hospital readmissions after acute stroke and TIA. The primary outcomes were hospital readmission rates during 30 days and 1 year after discharge. The primary causes and risk factors of hospital readmissions were also identified. Ten studies with 253,680 patients were eligible for inclusion. The pooled 30-day and 1-year hospital readmission rates were 17.4 % (95 % CI, 12.7–23.5 %) and 42.5 % (95 % CI, 34.1–51.3 %), respectively. The three major causes of 30-day hospital readmissions were infection (19.9 %), coronary artery disease (CAD) (17.8 %) and recurrent stroke (16.0 %) successively, while the three major causes were recurrent stroke (19.4 %), infection (19.3 %) and CAD (16.3 %) during 1 year’s follow-up. There were more patients with CAD in readmits group than that in control group (p = 0.030). The length of index admission, defined as any eligible admission to an acute care hospital assessed in the measure for the outcome, was longer (p = 0.000) and admission National Institutes of Health Stroke Score (NIHSS) was higher (p = 0.002) in readmits group than these in control group. In conclusion, there is high risk of early and long-term hospital readmissions after survival of acute stroke and TIA. These patients with coronary artery disease, longer length of index admission and higher NIHSS deserve deep attention after hospital discharge.

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References

  1. Feigin VL, Forouzanfar MH, Krishnamurthi R et al (2014) Global and regional burden of stroke during 1990–2010: findings from the global burden of disease study 2010. Lancet 383:245–255

    Article  PubMed  PubMed Central  Google Scholar 

  2. Kind AJ, Smith MA, Frytak JR, Finch MD (2007) Bouncing back: patterns and predictors of complicated transitions 30 days after hospitalization for acute ischemic stroke. J Am Geriatr Soc 55:365–373. doi:10.1111/j.1532-5415.2007.01091.x

    Article  PubMed  PubMed Central  Google Scholar 

  3. Nahab F, Takesaka J, Mailyan E, Judd L, Culler S, Webb A, Frankel M, Choi D, Helmers S (2012) Avoidable 30-day readmissions among patients with stroke and other cerebrovascular disease. Neurohospitalist 2:7–11. doi:10.1177/1941874411427733

    Article  PubMed  PubMed Central  Google Scholar 

  4. Rumball-Smith J, Hider P (2009) The validity of readmission rate as a marker of the quality of hospital care and a recommendation for its definition. N Z Med J 122:63–70

    PubMed  Google Scholar 

  5. Epstein AM, Jha AK, Orav EJ (2011) The relationship between hospital admission rates and rehospitalizations. N Engl J Med 365:2287–2295

    Article  CAS  PubMed  Google Scholar 

  6. Ahmad FS, Metlay JP, Barg FK, Henderson RR, Werner RM (2013) Identifying hospital organizational strategies to reduce readmissions. Am J Med Qual 28:278–285. doi:10.1177/1062860612464999

    Article  PubMed  Google Scholar 

  7. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the prisma statement. J Clin Epidemiol 62:1006–1012. doi:10.1016/j.jclinepi.2009.06.005

    Article  Google Scholar 

  8. Hu J, Chen R, Liu S, Yu X, Zou J, Ding X (2015) Global incidence and outcomes of adult patients with acute kidney injury after cardiac surgery: a systematic review and meta-analysis. J Cardiothorac Vasc Anesth 30:82–89. doi:10.1053/j.jvca.2015.06.017

    Article  PubMed  Google Scholar 

  9. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188

    Article  CAS  PubMed  Google Scholar 

  10. Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539–1558. doi:10.1002/sim.1186

    Article  PubMed  Google Scholar 

  11. Strowd RE, Wise SM, Umesi UN, Bishop L, Craig J, Lefkowitz D, Reynolds PS, Tegeler C, Arnan M, Duncan PW, Bushnell CD (2015) Predictors of 30-day hospital readmission following ischemic and hemorrhagic stroke. Am J Med Qual 30:441–446. doi:10.1177/1062860614535838

    Article  PubMed  Google Scholar 

  12. Shah SV, Corado C, Bergman D, Curran Y, Bernstein RA, Naidech AM, Prabhakaran S (2015) Impact of poststroke medical complications on 30-day readmission rate. J Stroke Cerebrovasc Dis 24:1969–1977. doi:10.1016/j.jstrokecerebrovasdis.2015.04.037

    Article  PubMed  Google Scholar 

  13. Bjerkreim AT, Thomassen L, Waje-Andreassen U, Selvik HA, Naess H (2015) Hospital readmission after intracerebral hemorrhage. J Stroke Cerebrovasc Dis. doi:10.1016/j.jstrokecerebrovasdis.2015.09.009

    Google Scholar 

  14. Qian FMDP, Fonarow GCMD, Smith EEMDMPH et al (2013) Racial and ethnic differences in outcomes in older patients with acute ischemic stroke. Circ Cardiovasc Qual Outcomes 6:284–292. doi:10.1161/circoutcomes.113.000211

    Article  PubMed  Google Scholar 

  15. Olson DM, Cox M, Pan W, Sacco RL, Fonarow GC, Zorowitz R, Labresh KA, Schwamm LH, Williams L, Goldstein LB, Bushnell CD, Peterson ED (2013) Adherence evaluation of acute ischemic stroke-longitudinal AR death and rehospitalization after transient ischemic attack or acute ischemic stroke: 1-year outcomes from the adherence evaluation of acute ischemic stroke-longitudinal registry. J Stroke Cerebrovasc Dis 22:181–188

    Article  Google Scholar 

  16. Li HW, Yang MC, Chung KP (2011) Predictors for readmission of acute ischemic stroke in taiwan. J Formos Med Assoc 110:627–633. doi:10.1016/j.jfma.2011.08.004

    Article  PubMed  Google Scholar 

  17. Lakshminarayan KMDP, Schissel CMPH, Anderson DCMD, Vazquez GP, Jacobs DRJP, Ezzeddine MMD, Luepker RVMDMS, Virnig BAPMPH (2011) Five-year rehospitalization outcomes in a cohort of patients with acute ischemic stroke: medicare linkage study. Stroke 42:1556–1562

    Article  PubMed  PubMed Central  Google Scholar 

  18. Tseng MC, Lin HJ (2009) Readmission after hospitalization for stroke in taiwan: results from a national sample. J Neurol Sci 284:52–55. doi:10.1016/j.jns.2009.04.009

    Article  PubMed  Google Scholar 

  19. Bravata DMMD, Ho S-YP, Meehan TPMD, Brass LMMD, Concato JMD (2007) Readmission and death after hospitalization for acute ischemic stroke: 5-year follow-up in the medicare population. Stroke 38:1899–1904. doi:10.1161/strokeaha.106.481465

    Article  PubMed  Google Scholar 

  20. Smith MAa, Liou JIa, Frytak JRb, Finch MDc (2006) 30-day survival and rehospitalization for stroke patients according to physician specialty. Cerebrovasc Dis 22:21–26

    Article  PubMed  PubMed Central  Google Scholar 

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The study was supported by no grant.

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Authors and Affiliations

  1. Department of Neurology, Qilu Hospital, Shandong University, 44 West Wenhua Road, Jinan, 250012, Shandong, People’s Republic of China

    Weibin Zhong & Lili Cao

  2. Department of Neurology, Weihai Municipal Hospital, 70 Heping Road, Weihai, 264200, Shandong, People’s Republic of China

    Na Geng, Pengfei Wang & Zhenguang Li

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  1. Weibin Zhong
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  2. Na Geng
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  3. Pengfei Wang
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  4. Zhenguang Li
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  5. Lili Cao
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Correspondence to Weibin Zhong or Lili Cao.

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Zhong, W., Geng, N., Wang, P. et al. Prevalence, causes and risk factors of hospital readmissions after acute stroke and transient ischemic attack: a systematic review and meta-analysis. Neurol Sci 37, 1195–1202 (2016). https://doi.org/10.1007/s10072-016-2570-5

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