Aneurysmal subarachnoid hemorrhage (aSAH) is a debilitating disease process accounting for 5% of strokes. While improvements in care have reduced case-fatality rates, patients are at increased risk for neurological and medical complications after discharge. Additionally, readmission rates are increasingly being used as a metric for patient care quality.
In this study, we reviewed the charts of 206 patients treated for aSAH at the University of Virginia between 2011 and 2018 to identify causes and predictors of readmission.
The all-cause readmission rate was 9.8%, 15.3%, and 21.3% within 30, 60, and 180 days, respectively. The readmission rate for neurologic causes was 7.7%, 12.6%, and 18.0% within 30, 60, and 180 days, respectively. Neurologic causes of readmission included aneurysm retreatment, cranioplasty, fall, hydrocephalus, stroke symptoms, and syncope. Surgical treatment (OR=4.11-6.30) and endovascular treatment for vasospasm (OR=3.79-8.33) were associated with increased risk for all-cause readmission. Endovascular aneurysm treatment (OR=0.22) was associated with decreased risk for all-cause readmission. The average time to first follow-up at our institution was 55.3 ± 63.3 days. Sixty-five percent of patients that were readmitted from the emergency room had not had follow-up contact with physicians at our institution until their readmission.
This is the first study that has examined readmission rates following subarachnoid hemorrhage beyond 90 days. Our results suggest that readmission rates beyond 90 days may still be predicted by hospital and treatment course during admission and that follow up with patients earlier in clinic could identify patients at higher risk for readmission.
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