1161. Nonindex Hospital Readmission After Ruptured Cerebral Aneurysm Treatment is Associated With Higher Morbidity and Repeat Readmission

Authors: Austin M. Tang, MPH; Joshua Bakhsheshian, MD; Li Ding, MD; Casey Jarvis, BA; Edith Yuan, BA; Ben Strickland, MD; Steven Giannotta, MD; Arun Amar, MD; Frank Attenello, MD, MS; William Mack, MD (Los Angeles, CA)

Introduction: Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating disease with high morbidity. Following initial care (index hospital), readmission to a different hospital (nonindex) has previously been associated with worse outcomes in a variety of non-neurosurgical cohorts. However, less is known about nonindex readmission outcomes for aSAH. Objectives: To characterize nonindex readmission rate, predictors, and morbidity after ruptured aneurysm treatment. Methods: Readmissions after aneurysmal subarachnoid hemorrhage treatment were identified from the 2010-2014 Nationwide Readmissions Databases. 90-day readmissions to a hospital different from the original treatment site were characterized as nonindex readmissions. Multivariable logistic regression models were used to identify patient and hospital characteristics independently associated with nonindex readmission. Separate multivariable models evaluated if readmission to a nonindex hospital was associated with increased morbidity or risk of further readmission. Results: 9,245 patients were admitted for treatment of ruptured aneurysms over a 5-year period. Of these patients, 1,985 patients were readmitted, with 355 (17.9%) to nonindex hospitals. Patients that received care at privately owned hospitals (OR=1.70, p=0.02) or were discharged to a skilled nursing or other facility (OR=1.70, p=0.0004) had a higher likelihood for readmission to a nonindex hospital; having private insurance was associated with readmission to an index hospital (OR=0.65, p=0.014). Compared to index readmissions, patients readmitted to a nonindex hospital had higher rates of a major complication (OR=2.22, p<0.0001) and second readmission (OR=1.51, p=0.002). Conclusion: Following ruptured aneurysm treatment, 17.9% of readmissions occur at a different hospital. These patients are at increased risk for major complications or subsequent readmissions. This may be due to care fragmentation, and interventions aimed at improving continuity of care may help reduce nonindex readmission morbidity burden in this vulnerable patient population.