Introduction:
Patients with ischemic stroke (IS), intracerebral hemorrhage (ICH), or subarachnoid hemorrhage (SAH) who undergo mechanical ventilation (MV) frequently require tracheostomy for management of persistent respiratory failure. Given the potential complications of chronic immobility and respiratory failure, these patients may be at high risk for hospital readmission.
Methods:
Using previously validated ICD-9-CM codes and statewide administrative claims data from California (2005-2011), Florida (2005-2012), and New York (2006-2011), we compared readmission rates among patients with a first-recorded stroke (IS, ICH, or SAH) who received MV and were discharged with or without a tracheostomy. Survival statistics and Poisson regression analyses with robust standard errors were used to report rates of hospital readmission and the association between tracheostomy and readmission rates.
Results:
Among 39,881 patients with stroke who underwent MV, 10,690 received a tracheostomy. The rate of any readmission was 21.1% (95% CI 20.3-21.9%) at 1 month and 45.1% (95% CI 44.2-46.1%) at 1 year among patients with tracheostomy versus 17.1% (95% CI 16.6-17.5%) and 35.3% (95% CI 34.8-35.9%) among those without a tracheostomy. The overall readmission rate throughout follow-up was 5.03 (95% CI 5.00-5.07) readmissions per 100 patients per month in those with tracheostomy versus 3.69 (95% CI 3.64-3.73) in those without tracheostomy. After adjustment for stroke type, demographic characteristics, vascular risk factors, Elixhauser comorbidities, stroke complications (e.g., seizures), and discharge disposition from the index hospitalization, tracheostomy was associated with a slightly increased readmission rate (incidence rate ratio, 1.04; 95% CI 1.00-1.08, p=0.04).
Conclusion:
Readmission rates among mechanically ventilated patients with stroke were not substantially higher than overall readmission rates seen in the general hospitalized population of elderly patients. There was a statistically significant but not clinically meaningful association between tracheostomy placement and readmission rates. These data may be helpful when counseling the families of patients with severe stroke.
Effect of early mobilization on discharge disposition of mechanically ventilated patients