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Association between the LACE+ index and unplanned 30-day hospital readmissions in hospitalized patients with stroke
Adalia H Jun-O'Connell1, Eliza Grigoriciuc1, Brian Silver1
1Departments of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, United States.
Insights
The LACE+ index effectively predicts unplanned 30-day hospital readmissions for stroke patients. Higher LACE+ scores indicate increased readmission risk, validating its use in stroke care.
Area of Science:
- Neurology
- Healthcare Management
- Biostatistics
Background:
- The LACE+ index is established for predicting general hospital readmissions.
- Its effectiveness in predicting 30-day readmissions specifically for stroke patients remains unverified.
Purpose of the Study:
- To evaluate the LACE+ index's utility in predicting 30-day unplanned readmissions in hospitalized stroke patients.
- To determine if LACE+ score is an independent predictor of readmission post-stroke.
Main Methods:
- Retrospective analysis of 1,657 stroke patients (ischemic/hemorrhagic) from an institutional registry (Jan 2018-Aug 2020).
- Primary outcome: unplanned 30-day readmission. LACE+ index categorized risk into low, medium, medium-to-high, and high.
- Statistical analyses included Kaplan-Meier, Log rank test, and multivariable Cox regression.
Main Results:
- Overall 30-day unplanned readmission rate was 11.7%.
- Median LACE+ score was significantly higher in patients readmitted within 30 days (74 vs. 70, p < 0.001).
- High LACE+ risk category independently predicted increased 30-day readmission risk (HR 1.67, p = 0.001).
Conclusions:
- The LACE+ index is a valid tool for predicting 30-day unplanned readmissions in stroke patients.
- High LACE+ scores correlate with significantly higher readmission risks.
- Further research should explore LACE+ score-guided interventions to reduce stroke readmissions.
Background:
The LACE+ index is used to predict unplanned 30-day hospital readmissions, but its utility to predict 30-day readmission in hospitalized patients with stroke is unknown.
Methods:
We retrospectively analyzed 1,657 consecutive patients presenting with ischemic or hemorrhagic strokes, included in an institutional stroke registry between January 2018 and August 2020. The primary outcome of interest was unplanned 30-day readmission for any reason after index hospitalization for stroke. The 30-day readmission risk was categorized by LACE+ index to high risk (≥78), medium-to-high risk (59-77), medium risk (29-58), and low risk (≤ 28). Kaplan-Meier analysis, Log rank test, and multivariable Cox regression analysis (with backward elimination) were used to determine whether the LACE+ score was an independent predictor for 30-day unplanned readmission.
Results:
The overall 30-day unplanned readmission rate was 11.7% (194/1,657). The median LACE+ score was higher in the 30-day readmission group compared to subjects that had no unplanned 30-day readmission [74 (IQR 67-79) vs. 70 (IQR 62-75); p < 0.001]. On Kaplan-Meier analysis, the high-risk group had the shortest 30-day readmission free survival time as compared to medium and medium-to-high risk groups (p < 0.01, each; statistically significant). On fully adjusted multivariable Cox-regression, the highest LACE+ risk category was independently associated with the unplanned 30-day readmission risk (per point: HR 1.67 95%CI 1.23-2.26, p = 0.001).
Conclusion:
Subjects in the high LACE+ index category had a significantly greater unplanned 30-day readmission risk after stroke as compared to lower LACE+ risk groups. This supports the validity of the LACE+ scoring system for predicting unplanned readmission in subjects with stroke. Future studies are warranted to determine whether LACE+ score-based risk stratification can be used to devise early interventions to mitigate the risk for unplanned readmission.
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