Majority of 30-day readmissions after intracerebral hemorrhage are related to infections

Aaron S. Lord, Ariane Lewis, Barry Czeisler, Koto Ishida, Jose Torres, Hooman Kamel, Daniel Woo, Mitchell S.V. Elkind, Bernadette Boden-Albala

Research output: Contribution to journalArticle

Abstract

Background and Purpose - Infections are common after intracerebral hemorrhage, but little is known about the risk of serious infection requiring readmission after hospital discharge. Methods - To determine if infections are prevalent in patients readmitted within 30 days of discharge, we performed a retrospective cohort study of patients discharged from nonfederal acute care hospitals in California with a primary diagnosis of intracerebral hemorrhage between 2006 and 2010. We excluded patients who died during the index admission, were discharged against medical advice, or were not California residents. Our main outcome was 30-day unplanned readmission with primary infection-related International Classification of Diseases, Ninth Revision, Clinical Modification code. Results - There were 24 540 index intracerebral hemorrhage visits from 2006 to 2010. Unplanned readmissions occurred in 14.5% (n=3550) of index patients. Of 3550 readmissions, 777 (22%) had an infection-related primary diagnosis code. When evaluating primary and all secondary diagnosis codes, infection was associated with 1826 (51%) of readmissions. Other common diagnoses associated with readmission included stroke-related codes (n=840, 23.7%) and aspiration pneumonitis (n=154, 4.3%). The most common infection-related primary diagnosis codes were septicemia (n=420, 11.8%), pneumonia (n=124, 3.5%), urinary tract infection (n=141, 4.0%), and gastrointestinal infection (n=42, 1.2%). Patients with a primary infection-related International Classification of Diseases, Ninth Revision, Clinical Modification code on readmission had higher in-hospital mortality compared with other types of readmission (15.6% versus 8.0%, P<0.001). After controlling for other predictors of mortality, primary infection-related readmissions remained associated with in-hospital mortality (relative risk, 1.7; 95% confidence interval, 1.3-2.2). Conclusions - Infections are associated with a majority of 30-day readmissions after intracerebral hemorrhage and increased mortality. Efforts should be made to reduce infection-related complications after hospital discharge.

Original languageEnglish (US)
Pages (from-to)1768-1771
Number of pages4
JournalStroke
Volume47
Issue number7
DOIs
StatePublished - Jul 1 2016

Keywords

  • epidemiology
  • health services research
  • pneumonia
  • stroke
  • urinary tract infection

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

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    Lord, A. S., Lewis, A., Czeisler, B., Ishida, K., Torres, J., Kamel, H., Woo, D., Elkind, M. S. V., & Boden-Albala, B. (2016). Majority of 30-day readmissions after intracerebral hemorrhage are related to infections. Stroke, 47(7), 1768-1771. https://doi.org/10.1161/STROKEAHA.116.013229