1056. Comparison of Readmission to Index vs Non-index Hospitals after Thrombolysis Administration in Acute Stroke Patients
Authors: Kristina Shkirkova; Michelle Connor, BA; Krista Lamorie-Foote, BA; Arati Patel; Qinghai Liu; Li Ding; Nerses Sanossain; Frank Attenello; William Mack (Los Angeles, CA)
Readmission to a non-index hospital is associated with a less favorable outcome following a number of medical and surgical conditions. National and regional systems of stroke care are designed to provide patients with widespread access to hospitals with thrombolytic capabilities. However, such decentralized systems may contribute to fragmentation of care and negatively affect patient outcomes in cases of readmission.
This study utilized a population-based, nationally sample of stroke patients who underwent thrombolytic therapy from the National Readmissions Database from 2010 to 2014. Descriptive and dichotomized analyses were performed to determine patient and hospital level factors that influenced 90-day readmissions to index and non-index hospitals. Regression models were used to identify differences in mortality, complications and subsequent readmissions between patients readmitted to index and non-index hospitals.
During the study period, 49415 stroke patients were treated with IV-TPA, of whom 10718 (21.7%) were readmitted within 90 days. The most frequent reasons for readmission were cerebral artery occlusion (8.73%), septicemia (5.83%), and carotid artery occlusion (5.22%). Among 90-day readmissions, 8514 (79.4%) patients were readmitted to the index hospital and 2204 (20.6%) to non-index hospitals. On multivariable logistic regression analysis, mortality, major complications, and neurological complications were not independently associated with readmission to index or non-index hospital (p=NS). However, non-index hospital readmission was independently associated with higher frequency of second readmissions (OR 1.6,95%CI 1.42-1.75, p<0.0001).
Approximately one-fifth of stroke patients treated with IV-TPA were readmitted within 90 days, one-fifth of whom are readmitted to non-index hospitals. Although readmission to index hospital was associated with lower frequency of subsequent readmissions, readmission to non-index hospital was not associated with increased mortality or major complications as seen in prior studies of other diseases processes. This difference may be due to standardized algorithms, mature systems of care, and demanding metrics required of stroke centers.