Readmissions and Mortality During the First Year After Stroke-Data From a Population-Based Incidence Study

Pedro Abreu; Rui Magalhães; Diana Baptista; Elsa Azevedo; Maria Carolina Silva; Manuel Correia

doi:10.3389/fneur.2020.00636

Readmissions and Mortality During the First Year After Stroke-Data From a Population-Based Incidence Study

Front Neurol. 2020 Jul 24:11:636. doi: 10.3389/fneur.2020.00636. eCollection 2020.

Authors

Pedro Abreu^{1

2}, Rui Magalhães³, Diana Baptista², Elsa Azevedo^{1

2}, Maria Carolina Silva³, Manuel Correia^{3

4}

Affiliations

¹ Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal.
² Department of Clinical Neurosciences and Mental Health, Faculdade de Medicina, Universidade Do Porto, Porto, Portugal.
³ Instituto de Ciências Biomédicas Abel Salazar, Universidade Do Porto, Porto, Portugal.
⁴ Department of Neurology, Hospital Santo António-Centro Hospitalar Universitário Do Porto, Porto, Portugal.

Abstract

Background: After a first-ever-in-a-lifetime stroke (FELS), hospital readmissions are common and associated with increased mortality and morbidity of stroke survivors, thus, raising the overall health burden of stroke. Population-based stroke studies on hospital readmissions are scarce despite it being an important healthcare service quality indicator. We evaluated unplanned readmissions or death during the first year after a FELS and their potential factors, based on a Portuguese community register. Methods: Data were retrieved from a population-based prospective register undertaken in Northern Portugal (ACIN2) in 2009-2011. Retrospective information about unplanned hospital readmissions and case fatality within 1 year after FELS index hospitalization (FELS-IH) was evaluated. Readmission/death-free survival 1 year after discharge was estimated using the Kaplan-Meyer method. Independent risk factors for readmission/death were identified using Cox proportional hazard models. Results: Unplanned readmission/death within 1 year occurred in 120 (31.6%) of the 389 hospitalized FELS survivors. In 31.2% and 33.5% of the cases, it occurred after ischemic stroke or intracerebral hemorrhage, respectively. Infections and cerebrovascular and cardiovascular diseases were the main causes of readmission. Of the readmissions, 65.3% and 52.5% were potentially avoidable or stroke related, respectively. The main cause of potentially avoidable readmissions was the continuation/recurrence of the event responsible for the initial admission or a closely related condition (71.2%). Male sex, age, previous and post-stroke functional status, and FELS-IH length of stay were independent factors of readmission/death within 1 year. Conclusions: Almost one-third of FELS survivors were readmitted/dead 1 year after their FELS-IH. This outcome persisted after the first months after stroke hospitalization in all stroke subtypes. More than half of readmissions were considered potentially avoidable or stroke related.

Keywords: community-based study; epidemiology; mortality; outcome; stroke readmissions.