title: Hospital Readmissions of Stroke Patients with Percutaneous Endoscopic Gastrostomy Feeding Tubes.
abstract: OBJECTIVE
  A critical mission of acute care hospitals is to reduce hospital readmissions to improve patient care and avoid monetary penalties. We speculated that stroke patients with enteral tube feeding are high-risk patients and sought to evaluate their hospital readmissions.
  
  
  METHODS
  We analyzed archival hospital billing data from stroke patients discharged from acute care hospitals in Florida in 2012 for 30- and 60-day readmission rates, 30-day readmission rates by discharge destination, most frequent primary readmission diagnoses, and predictors of 30-day readmissions. We conducted univariate and multivariable logistic regression analyses.
  
  
  RESULTS
  We analyzed 26,774 discharge records. Within 30 days after discharge, 21.06% (N = 299) of stroke patients with percutaneous endoscopic gastrostomy (PEG) tube placement were rehospitalized. Of those readmissions, 11.71% (N = 35) were preventable. Among stroke patients with a PEG tube placement, 53.80% were discharged to skilled nursing facilities and 27.88% were rehospitalized within 30 days. Septicemia was the most frequent primary readmission diagnosis. Comorbidities, stroke type, length of hospital stay, and discharge destinations were predictive for 30-day readmissions (area under the receiver operating characteristic curve was .81).
  
  
  CONCLUSIONS
  Stroke patients with a PEG tube placement during their index hospital stay are twice as likely to be readmitted within 30 days compared to stroke patients without PEG tube placements. The primary readmission diagnosis for some patients was directly linked to PEG tube complications. We have identified risk factors that can be used to focus resources for readmission prevention.
authors.affiliation: Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Janina
authors.initials: J
authors.lastname: Wilmskoetter
authors.affiliation: Department of Healthcare Leadership and Management, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Kit N
authors.initials: KN
authors.lastname: Simpson
authors.affiliation: Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina; Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina. Electronic address: bonilhah@musc.edu.
authors.forename: Heather S
authors.initials: HS
authors.lastname: Bonilha
mesh_terms: D000067575:Administrative Claims, Healthcare; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D004750:Enteral Nutrition / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D005431:Florida; D005773:Gastroscopy / Q000009:adverse effects*; D005774:Gastrostomy / Q000009:adverse effects*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010351:Patient Discharge; D010359:Patient Readmission; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D018805:Sepsis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D012866:Skilled Nursing Facilities; D020521:Stroke / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D000071939:Stroke Rehabilitation / Q000009:adverse effects* / Q000379:methods; D013997:Time Factors
keywords: Stroke; complications; enteral nutrition; patient readmission; risk factors