Abstract 077: Readmission Rates and Etiologies among Patients with Subarachnoid Hemorrhage: A Nationwide United States Analysis

Abstract

Introduction Subarachnoid Hemorrhage (SAH) is the leading cause of morbidity and mortality in stroke patients, associated with severe neurological, infectious, and thromboembolic complications. Identifying clinical predictors linked to hospital readmissions after a SAH allows for the determination of patients with higher risks of complications, opening an avenue for prevention and improved quality of care. Methods The Nationwide Readmission Database (NRD) was used to extract patients with SAH (ICD‐10 code: I60.x) from 2016‐2019. The difference in days between the index admission and the readmission was used to identify patients who were readmitted within 30 and 90 days. The primary diagnosis of the readmission was used to identify the etiology of readmission. Data was weighted to allow for representative nationwide estimates. Results We identified 68,726 patients with SAH, with a mean age of 60.47 years, and 57.86% being female. Overall, 7.79% (n=5354) were readmitted within 30 days and 12.04% (n=8525) were readmitted within 90 days. The rate of 30‐day readmission was overall stable (7.34% in 2016 and 7.70% in 2019; p=0.42), but the 90‐day readmission rate slightly increased from 11.69% in 2016 to 12.47% in 2019 (p=0.04). Around 62% of 90‐day readmissions occurred within the first 30 days. Patients readmitted within 30 days were more likely to be older (mean age = 61.92 vs 60.99 years; p<0.001) and male (43.96% vs 41.74%; p=0.002) compared to those not requiring readmission. They had a higher prevalence of diabetes (23.38% vs 18.82%), hypertension (74.34% vs 70.12%), obesity (13.95% vs 12.25%), dyslipidemia (38.17% vs 33.02%), smoking (39.30% vs 37.43%), prior TIA/ischemic stroke (22.60% vs 20.39%), coronary artery disease (15.03%), DVT (6.06% vs 3.51%), peripheral vascular disease (14.24% vs 11.09%), chronic renal failure (13.34% vs 9.35%), and heart failure (10.57% vs 7.75%) (p<0.001 for all). The most common etiologies of 30‐ and 90‐day readmission were cardiovascular (42.53% and 40.79%), neurological (12.34% and 11.50%), and infectious (8.41% and 8.21%). Conclusion The annual rate of 90‐day readmission, but not 30‐day readmission, increased from 2016 to 2019. Readmitted patients both within 30 and 90 days were more likely to have a higher prevalence of vascular risk factors and related comorbidities.. The most common cause of 30‐ and 90‐day readmission is cardiovascular diseases followed by neurological and infectious conditions. Further studies are required to offer risk stratification and prevention strategies for readmission among patients with Subarachnoid Hemorrhage.