title: Impact of Poststroke Medical Complications on 30-Day Readmission Rate.
abstract: BACKGROUND
  Some previously identified predictors of 30-day stroke readmission, including age and stroke severity, are nonmodifiable. We assessed the hypothesis that in-hospital medical complications, which are potentially modifiable, after ischemic stroke (IS) and transient ischemic attack (TIA) predict 30-day readmission.
  
  
  METHODS
  In a single-center prospective cohort study of IS and TIA patients admitted from August 1, 2012, to July 31, 2013, we identified those who survived to 30-day follow-up or died during a readmission within 30 days. Patients readmitted within 30 days of discharge were identified by telephone assessment and review of hospital records. We evaluated the association between 12 prespecified and prospectively collected poststroke medical complications and 30-day readmission adjusting for baseline characteristics, in-hospital course and treatments, and discharge status using univariable and multivariable Cox proportional hazards models.
  
  
  RESULTS
  Among 505 patients, 107 (21.2%) patients had at least 1 medical complication during hospitalization. The most common complications were urinary tract infection (8.7%), venous thromboembolism (6.1%), and pneumonia (4.6%). Seventy-eight (15.4%) patients were readmitted within 30 days. On multivariable Cox proportional hazards analysis, cardioembolic or large-artery atherosclerotic subtype (adjusted hazard ratio [HR], 1.82; 95% confidence interval [CI], 1.17-2.83) and any medical complication (adjusted HR, 1.68; 95% CI, 1.04-2.73) increased the risk of 30-day readmission. Among the 24 readmitted patients who experienced an initial medical complication, 10 (41.6%) were considered potentially preventable.
  
  
  CONCLUSIONS
  The occurrence of medical complications after IS or TIA increased the risk of 30-day all-cause readmission. Stroke patients with medical complications may be suitable for targeted interventions to prevent readmissions.
authors.affiliation: Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Sonia V
authors.initials: SV
authors.lastname: Shah
authors.affiliation: Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Carlos
authors.initials: C
authors.lastname: Corado
authors.affiliation: Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Deborah
authors.initials: D
authors.lastname: Bergman
authors.affiliation: Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Curran
authors.affiliation: Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Bernstein
authors.affiliation: Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Naidech
authors.affiliation: Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Electronic address: shyam.prabhakaran@northwestern.edu.
authors.forename: Shyam
authors.initials: S
authors.lastname: Prabhakaran
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000209:etiology / Q000628:therapy
keywords: Medical complications; health policy; outcomes; recurrent stroke