Hospital Readmission Rates Among Mechanically Ventilated Patients With Stroke.
OBJECTIVE
Tracheostomy is frequently performed in patients with severe ischemic stroke, intracerebral hemorrhage, or subarachnoid hemorrhage. Little is known about readmission rates among stroke patients who undergo mechanical ventilation.


METHODS
We used previously validated International Classification of Diseases, Ninth Edition-Clinical Modification codes and data on all discharges from nonfederal acute care hospitals in 3 states. We compared readmission rates among mechanically ventilated patients with stroke who were discharged with or without a tracheostomy.


RESULTS
Among 39,881 patients who underwent mechanical ventilation during the index stroke hospitalization and survived to discharge, 10,690 (26.8%; 95% confidence interval, 26.4%-27.2%) underwent tracheostomy. During a mean follow-up period of 3.4 (±2.0) years, the overall incidence rate of readmissions was 4.25 (95% confidence interval, 4.22-4.28) per 100 patients per 30 days. The rate of any readmissions within 30 days was 26.9% among patients with tracheostomy compared with 22.5% among those without a tracheostomy (absolute risk difference, 4.4%; 95% confidence interval, 3.5%-5.4%; P<0.001). After adjustment for potentially confounding variables, tracheostomy was associated with a slightly increased readmission rate (incidence rate ratio, 1.07; 95% confidence interval, 1.03-1.11).


CONCLUSIONS
Approximately one quarter of mechanically ventilated patients with stroke who survive to discharge are readmitted to the hospital within 30 days. Readmission rates are significantly higher in patients with stroke who undergo tracheostomy, but the difference is not clinically meaningful. Thirty-day readmission rates among mechanically ventilated patients with stroke are similar to Medicare beneficiaries hospitalized with major medical diseases such as pneumonia.
From the Departments of Neurology and Neurosurgery (S.L.) and Neurology, Neurosurgery, and Biomedical Sciences (A.R.), Cedars-Sinai Medical Center, Los Angeles; Department of Neurology (B.B.N., A.E.M., H.K.), Feil Family Brain and Mind Research Institute (B.B.N., H.K.), Weill Cornell Medical College, New York, NY; Departments of Neurology and Neurosurgery, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, NY (S.A.M.); and Department of Neurology, Columbia College of Physicians and Surgeons, New York, NY (A.E.M., J.C.). shouri.lahiri@cshs.org.
Shouri
S
Lahiri
From the Departments of Neurology and Neurosurgery (S.L.) and Neurology, Neurosurgery, and Biomedical Sciences (A.R.), Cedars-Sinai Medical Center, Los Angeles; Department of Neurology (B.B.N., A.E.M., H.K.), Feil Family Brain and Mind Research Institute (B.B.N., H.K.), Weill Cornell Medical College, New York, NY; Departments of Neurology and Neurosurgery, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, NY (S.A.M.); and Department of Neurology, Columbia College of Physicians and Surgeons, New York, NY (A.E.M., J.C.).
Babak B
BB
Navi
From the Departments of Neurology and Neurosurgery (S.L.) and Neurology, Neurosurgery, and Biomedical Sciences (A.R.), Cedars-Sinai Medical Center, Los Angeles; Department of Neurology (B.B.N., A.E.M., H.K.), Feil Family Brain and Mind Research Institute (B.B.N., H.K.), Weill Cornell Medical College, New York, NY; Departments of Neurology and Neurosurgery, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, NY (S.A.M.); and Department of Neurology, Columbia College of Physicians and Surgeons, New York, NY (A.E.M., J.C.).
Stephan A
SA
Mayer
From the Departments of Neurology and Neurosurgery (S.L.) and Neurology, Neurosurgery, and Biomedical Sciences (A.R.), Cedars-Sinai Medical Center, Los Angeles; Department of Neurology (B.B.N., A.E.M., H.K.), Feil Family Brain and Mind Research Institute (B.B.N., H.K.), Weill Cornell Medical College, New York, NY; Departments of Neurology and Neurosurgery, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, NY (S.A.M.); and Department of Neurology, Columbia College of Physicians and Surgeons, New York, NY (A.E.M., J.C.).
Axel
A
Rosengart
From the Departments of Neurology and Neurosurgery (S.L.) and Neurology, Neurosurgery, and Biomedical Sciences (A.R.), Cedars-Sinai Medical Center, Los Angeles; Department of Neurology (B.B.N., A.E.M., H.K.), Feil Family Brain and Mind Research Institute (B.B.N., H.K.), Weill Cornell Medical College, New York, NY; Departments of Neurology and Neurosurgery, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, NY (S.A.M.); and Department of Neurology, Columbia College of Physicians and Surgeons, New York, NY (A.E.M., J.C.).
Alexander E
AE
Merkler
From the Departments of Neurology and Neurosurgery (S.L.) and Neurology, Neurosurgery, and Biomedical Sciences (A.R.), Cedars-Sinai Medical Center, Los Angeles; Department of Neurology (B.B.N., A.E.M., H.K.), Feil Family Brain and Mind Research Institute (B.B.N., H.K.), Weill Cornell Medical College, New York, NY; Departments of Neurology and Neurosurgery, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, NY (S.A.M.); and Department of Neurology, Columbia College of Physicians and Surgeons, New York, NY (A.E.M., J.C.).
Jan
J
Claassen
From the Departments of Neurology and Neurosurgery (S.L.) and Neurology, Neurosurgery, and Biomedical Sciences (A.R.), Cedars-Sinai Medical Center, Los Angeles; Department of Neurology (B.B.N., A.E.M., H.K.), Feil Family Brain and Mind Research Institute (B.B.N., H.K.), Weill Cornell Medical College, New York, NY; Departments of Neurology and Neurosurgery, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, NY (S.A.M.); and Department of Neurology, Columbia College of Physicians and Surgeons, New York, NY (A.E.M., J.C.).
Hooman
H
Kamel
D002543:Cerebral Hemorrhage / Q000150:complications / Q000628:therapy*; D006801:Humans; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012121:Respiration, Artificial / Q000379:methods*; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000628:therapy*; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000628:therapy*; D014139:Tracheostomy / Q000706:statistics & numerical data
hemorrhage; hospital readmission; respiration, artificial; stroke; tracheostomy