Factors influencing time spent in hospital for unscheduled readmissions after stroke discharge

Unscheduled hospital readmission following stroke is common and has a significant effect on quality of life for patients and their families. However, there is limited evidence on the factors associated with unscheduled hospital readmission time in the first-year post-stroke discharge. This study aims to investigate patient and healthcare system factors associated with unscheduled hospital readmission time in a cohort of first-ever stroke patients in Scotland, UK.

This is a population-level data-linkage study using data on adult stroke patients admitted to hospital between 2010 and 2018, with follow-up to end of 2019. The association between unscheduled hospital readmission time and patient and healthcare system factors was assessed using multivariable zero-inflated negative binomial estimations.

Among the 48,040 stroke patients (median age 73 years [interquartile range (IQR) 63-82]; 48.7% female) included in the study, 14,794 (30.8%) had at least one unscheduled readmission in the 1-year post-stroke discharge follow-up (median age 76 years [IQR 66-83]; 51.5% female). Median time spent in hospital as an unscheduled readmission in the 1-year follow-up was 9 days [IQR 3-25]. After adjustment, an increased risk of total unscheduled readmission time was associated with increasing age (≥ 80 years versus < 50 years Incidence Rate Ratio (IRR) 2.23 (95% CI 1.96-2.53)); living alone before stroke (IRR 1.17 (95% CI 1.11-1.24)); stroke severity (most versus least severe IRR 1.14 (95% CI 1.04-1.26)); intracerebral hemorrhage (IRR 1.29 (95% CI 1.18-1.42)); higher Charlson Comorbidity Index (CCI) (⩾3 versus 0 IRR 1.17 (95% CI 1.08-1.26)); higher frailty index (severe versus none IRR 1.16 (1.01-1.35); and longer length of stay for initial stroke admission (>10 days IRR 1.28 (95% CI 1.21-1.36)). Reduced risk of unscheduled readmission time was associated with lower socio-economic deprivation (least versus most deprived IRR 0.91 (95% CI 0.83-0.99)); prior transient ischaemic attack (TIA) (IRR 0.85 (95% CI 0.75-0.96)); and receipt of complete stroke care bundle (IRR 0.94 (95% CI 0.88-0.99)).

Increased unscheduled hospital readmission time was associated with several factors including living alone, a higher comorbidity burden, stroke severity, and stroke type. Greater community support for these at-risk patients in terms of living arrangements and more pro-active outpatient management of comorbidities may be needed to reduce unscheduled readmission time following stroke discharge.