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Readmissions in patients with cerebral cavernous malformations: a national readmission database study
Akhil Padarti1, Amod Amritphale2, Javed K Eliyas3
1Department of Neurology, University of South Alabama, Mobile, AL, USA.
Insights
Nearly 15% of cerebral cavernous malformation (CCM) patients face 30-day readmission. Comorbidities like substance abuse and diabetes increase risk, while certain factors offer protection, aiding in identifying high-risk patients.
Area of Science:
- Neurology
- Vascular Biology
- Health Services Research
Background:
- Cerebral cavernous malformations (CCMs) are vascular lesions in the central nervous system (CNS) that can cause stroke and seizures.
- Aggressive CCM disease leads to frequent hemorrhages, hospitalizations, and significant healthcare costs.
- Understanding readmission rates and associated factors is crucial for managing CCM patient care and disease burden.
Purpose of the Study:
- To identify patients with cerebral cavernous malformations (CCMs) at high risk for all-cause readmission.
- To determine comorbidities associated with increased readmission rates in CCM patients.
Main Methods:
- Utilized the 2017 National Readmission Database (NRD) to analyze US hospital admissions for CCMs.
- Identified and analyzed patients readmitted within 30 days of discharge from their initial hospitalization.
Main Results:
- 14.9% of hospitalized CCM patients experienced all-cause readmission within 30 days.
- Substance abuse, diabetes, gastrointestinal bleed, renal failure, and coronary artery disease predicted readmission.
- Age 65-74, private insurance, and treatment at metropolitan teaching hospitals were protective factors.
Conclusions:
- Identified comorbidities linked to higher readmission risk suggest a role for vascular stress in CCM pathogenesis.
- This study is the first to analyze readmission metrics for CCMs to identify high-risk patient factors.
Background:
Cerebral cavernous malformations (CCMs) are microvascular CNS lesions prone to hemorrhage leading to neurological sequela such as stroke and seizure. A subset of CCM patients have aggressive disease leading to multiple bleeding events, likely resulting multiple hospitalizations. Hospital admission rates are an important metric that has direct financial impact on hospitals and an indicator of overall disease burden. Furthermore, analysis of hospital readmissions can lead to early identification of high-risk patients and provides insight into the pathogenesis of CCM lesions. The purpose of this study is to identify high risk CCM patients with increased all cause readmission and comorbidities associated with increased readmissions.
Methods:
All US hospital admissions due to CCMs were searched using the 2017 National Readmission Database (NRD). Patients with readmissions within 30 days of discharge from index hospitalization were identified and analyzed, relative to the remaining population.
Results:
Among all patients hospitalized for CCM, 14.9% (13.7-16.2%) required all cause readmission within 30 days. Multivariate logistical regression analysis showed that substance abuse (P=0.003), diabetes (P=0.018), gastrointestinal bleed (P=0.002), renal failure (P=0.027), and coronary artery disease (P=0.010) were predictive of all cause readmissions, while age group 65-74 (P=0.042), private insurance (P<0.001), and treatment at a metropolitan teaching institution (P=0.039) were protective. Approximately half of all readmissions are caused by neurological (33.9%) and infectious (14.6%) etiologies. The 30-day lesion bleeding rate after index hospitalization is 0.8% (0.5-1.2%).
Conclusions:
All identified comorbidities associated with increased risks of readmission contribute to vascular stress, suggesting its role in lesion pathogenesis. This is the first and only study to analyze readmission metrics for CCMs in order to identify high risk patient factors to date.
