In the Journals

Predictors of readmission after thrombectomy for stroke identified

Salvador Cruz-Flores
Salvador Cruz-Flores

Approximately 1 in 8 patients who received endovascular thrombectomy for treatment of acute ischemic stroke are readmitted within 30 days, with diabetes and coagulopathy being among the most common predictors, researchers reported.

Readmission risk did not differ between patients who had endovascular thrombectomy with or without IV thrombolysis and patients who had IV thrombolysis alone, Islam Y. Elgendy, MD, from the division of cardiovascular medicine at the University of Florida, and colleagues wrote.

Elgendy and colleagues conducted a propensity score-matched analysis comparing risk for nonelective 30-day readmission between patients who had endovascular thrombectomy with or without IV thrombolysis and patients who had IV thrombolysis alone.

All patients were documented in the National Readmissions Database as having an admission for acute ischemic stroke in 2013 or 2014. After propensity matching, there were 10,541 patients who had endovascular thrombectomy with or without IV thrombolysis and 10,630 patients who had IV thrombolysis alone. In both groups, the mean age was 67 years and 49% were women.

According to the researchers, 30-day readmission occurred in 12.4% of the endovascular thrombectomy group and 12.6% of the IV thrombolysis alone group (HR = 0.98; 95% CI, 0.91-1.05).

Independent predictors of 30-day readmission included diabetes (HR = 1.25; 95% CI, 1.16-1.34), coagulopathy (HR = 1.16; 95% CI, 1.01-1.34), Medicare (HR = 1.47; 95% CI, 1.32-1.65) or Medicaid insurance (HR = 1.68; 95% CI, 1.46-1.94), and gastrostomy during index hospitalization (HR = 2.08; 95% CI, 1.88-2.3), but treatment with both endovascular thrombectomy and IV thrombolysis was not a predictor, Elgendy and colleagues wrote.

The most common reasons for readmission were infections (17.2%), cardiac causes (17%) and recurrent stroke or transient ischemic attack (14.8%), according to the researchers.

In a related editorial, Salvador Cruz-Flores, MD, MPH, from the department of neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, wrote that the findings “raise concerns about the effectiveness of [endovascular thrombectomy] and thrombolysis limiting disability in practice, the effectiveness of secondary prevention and the effectiveness and efficiency of systems of care, particularly at the transitions.”

He concluded that “Elgendy et al shine some light on the rate of readmissions related to stroke but do not really answer the question on how [endovascular thrombectomy] impacts that readmission rate.” – by Erik Swain

Disclosures: Elgendy reports no relevant financial disclosures. Please see the study for the other authors’ relevant financial disclosures. Cruz-Flores reports he consults for Novo Nordisk and Paraxel and serves on clinical events committees for various trials.

Salvador Cruz-Flores
Salvador Cruz-Flores

Approximately 1 in 8 patients who received endovascular thrombectomy for treatment of acute ischemic stroke are readmitted within 30 days, with diabetes and coagulopathy being among the most common predictors, researchers reported.

Readmission risk did not differ between patients who had endovascular thrombectomy with or without IV thrombolysis and patients who had IV thrombolysis alone, Islam Y. Elgendy, MD, from the division of cardiovascular medicine at the University of Florida, and colleagues wrote.

Elgendy and colleagues conducted a propensity score-matched analysis comparing risk for nonelective 30-day readmission between patients who had endovascular thrombectomy with or without IV thrombolysis and patients who had IV thrombolysis alone.

All patients were documented in the National Readmissions Database as having an admission for acute ischemic stroke in 2013 or 2014. After propensity matching, there were 10,541 patients who had endovascular thrombectomy with or without IV thrombolysis and 10,630 patients who had IV thrombolysis alone. In both groups, the mean age was 67 years and 49% were women.

According to the researchers, 30-day readmission occurred in 12.4% of the endovascular thrombectomy group and 12.6% of the IV thrombolysis alone group (HR = 0.98; 95% CI, 0.91-1.05).

Independent predictors of 30-day readmission included diabetes (HR = 1.25; 95% CI, 1.16-1.34), coagulopathy (HR = 1.16; 95% CI, 1.01-1.34), Medicare (HR = 1.47; 95% CI, 1.32-1.65) or Medicaid insurance (HR = 1.68; 95% CI, 1.46-1.94), and gastrostomy during index hospitalization (HR = 2.08; 95% CI, 1.88-2.3), but treatment with both endovascular thrombectomy and IV thrombolysis was not a predictor, Elgendy and colleagues wrote.

The most common reasons for readmission were infections (17.2%), cardiac causes (17%) and recurrent stroke or transient ischemic attack (14.8%), according to the researchers.

In a related editorial, Salvador Cruz-Flores, MD, MPH, from the department of neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, wrote that the findings “raise concerns about the effectiveness of [endovascular thrombectomy] and thrombolysis limiting disability in practice, the effectiveness of secondary prevention and the effectiveness and efficiency of systems of care, particularly at the transitions.”

He concluded that “Elgendy et al shine some light on the rate of readmissions related to stroke but do not really answer the question on how [endovascular thrombectomy] impacts that readmission rate.” – by Erik Swain

Disclosures: Elgendy reports no relevant financial disclosures. Please see the study for the other authors’ relevant financial disclosures. Cruz-Flores reports he consults for Novo Nordisk and Paraxel and serves on clinical events committees for various trials.