title: Predictors of 30-day readmission after subarachnoid hemorrhage.
abstract: BACKGROUND
  Readmission within 30 days is increasingly evaluated as a measure of quality of care. There are few data on the rates of readmission after subarachnoid hemorrhage (SAH).
  
  
  OBJECTIVE
  We sought to determine the predictors of 30-day readmission in patients with SAH.
  
  
  METHODS
  We prospectively identified 283 patients with SAH admitted between 2006 and 2012. Readmission was determined by means of an automated query with confirmation in the electronic medical record.
  
  
  RESULTS
  Overall, 21 (8 %) patients were readmitted for infection (n = 8), headache (n = 5), hydrocephalus (n = 4), cardiovascular causes (n = 2), medication-related complications (n = 1), and cerebral ischemia (n = 1). Readmission was associated with longer intensive care unit (ICU) length of stay (LOS) (15.4 [13.4-19.3] vs. 12.2 [8.2-18.5] days, P = 0.02), hospital LOS (22.2 [17.4-23.0] vs. 16.8 [12.0-24.1] days, P = 0.01), and placement of an external ventricular drain (EVD, OR 3.9, 95 % CI 1.3-12.0, P = 0.01). Readmission was not associated with admission neurologic grade, NIH Stroke scale at 14 days, modified Rankin scale at 3 months, history of cardiovascular disease, or radiographic cerebral infarction (P > 0.1).
  
  
  CONCLUSIONS
  Demographics, severity of neurologic injury, radiographic cerebral infarction, and outcomes were not associated with readmission after SAH. Markers of a more complicated hospital course (ICU and hospital LOS, EVD placement) were associated with 30-day readmission. Most readmissions were for infections acquired after discharge. Readmission within 30 days is difficult to predict, and, since the most common reason was infection acquired after discharge, it may be difficult to prevent without an integrated health system and coordinated care.
authors.affiliation: Department of Anesthesiology, Northwestern University Feinberg School of Medicine, 710 N Lake Shore Drive, Abbott Hall 1116, Chicago, IL, 60611, USA.
authors.forename: Mandeep
authors.initials: M
authors.lastname: Singh
authors.forename: James C
authors.initials: JC
authors.lastname: Guth
authors.forename: Eric
authors.initials: E
authors.lastname: Liotta
authors.forename: Adam R
authors.initials: AR
authors.lastname: Kosteva
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Bauer
authors.forename: Shyam
authors.initials: S
authors.lastname: Prabhakaran
authors.forename: Neil
authors.initials: N
authors.lastname: Rosenberg
authors.forename: Bernard R
authors.initials: BR
authors.lastname: Bendok
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Maas
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Naidech
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D013997:Time Factors; D014696:Ventriculostomy / Q000706:statistics & numerical data
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