부산대학교 도서관

Background:Reducing 30-day readmission can potentially improve quality of stroke care. We investigated factors associated with 30-day readmission,1-year mortality and stroke recurrence post-ischemic stroke.Methods:Cohort included primary ischemic stroke discharges 1/1/2015 to 3/31/2021 from a large racial-ethnically diverse integrated healthcare delivery system. Assessment included demographics, comorbidity, NIHSS, IV thrombolytic, thrombectomy, hospital complications, and mRS score at discharge. Multivariate analysis was done to determine predictors for 30-day readmission, 1-year mortality and stroke recurrence.Results:Of 13,053 ischemic stroke patients,1,790 (13.7%) were readmitted within 30 days. The median time to readmission was 10 days (IQR 4-19). Readmission was most-commonly stroke-related (21.6%). Being older, having higher initial NIHSS or co-morbidity score or more hospital complications, not receiving IV thrombolysis, and being more disabled at discharged were seen more often among those who were readmitted (Table). In multivariate analysis, being older, having higher initial NIHSS and co-morbidity score were associated with higher odds of being readmitted by 30-day and having higher mortality and stroke recurrence at 1-year. Adjusted odds for stroke recurrence were elevated for black patients. Being readmitted by 30-day also predicted greater odds of 1-year stroke recurrence and 1-year mortality. On the other hand, receiving IV thrombolysis was associated with significantly less odds of being readmitted at 30-day (OR=0.74; 95% CI = 0.59 - 0.93) and less stroke recurrence (OR=0.75; 95% CI =0.64 - 0.87) and less mortality at 1-year (OR=0.57; 95% CI = 0.42 - 0.76).Conclusions:A number of factors predicted 30-day readmission as well as 1-year stroke recurrence and mortality. Receiving IV thrombolytic for acute stroke was strongly associated with lower odds of developing bad outcomes.