Hospital readmission in stroke survivors one year versus three years after discharge from inpatient rehabilitation: Prevalence and associations in an Asian cohort
Matthew Rong Jie Tay
Physiotherapy Department, Tan Tock Seng Hospital, Singapore, Singapore. E-mail: email@example.com
Objective: To examine the prevalence and risk factors for readmission after inpatient rehabilitation in stroke survivors, in a developed multi-ethnic Southeast Asian country.
Methods: A retrospective cohort study of 1,235 stroke survivors who completed inpatient rehabilitation in a tertiary rehabilitation centre.
Results: A total of 296 (24.0%) patients with stroke were readmitted within the first year, and 87 (7.0%) patients were readmitted 1–3 years after stroke. Significant risk factors for readmission of patients in the first year post-stroke were older age (p = 0.027), lower admission Functional Independence Measure (FIM) motor (p = 0.001) and cognition scores (p = 0.025), a Charlson Comorbidity Index (CCI) ≥1 (p < 0.001) and the presence of at least 1 medical complication during initial hospitalization (p < 0.001), while FIM gain was found to be protective (p < 0.001). Looking at readmission after 1 year post-stroke, a CCI≥1 (p < 0.001) and the presence of medical complications during initial hospitalization (p < 0.001) were risk factors for readmission, while FIM gain (p = 0.001) was protective. Common causes for readmission include recurrent stroke and falls.
Conclusion: There is a high readmission rate in stroke survivors, even after the first year post-stroke. Interventions, such as fall risk assessments, vaccinations, meticulous catheter care, intensified secondary risk factors interventions and continued post-discharge rehabilitation, may hold promise for reducing readmission rates.
Readmission of stroke patients results in high morbidity and healthcare costs. Although many studies have examined readmission of stroke survivors in the first year post-stroke, there is a scarcity of studies into readmission after the first year post-stroke, and the effect of rehabilitation on these patients. This study investigated 1,235 patients 3 years post-stroke rehabilitation. Of these patients, 296 (24.0%) were readmitted within the first year, and 87 (7.0%) were readmitted 1–3 years post-stroke. Significant risk factors for readmission included older age, lower functional scores on admission, presence of chronic medical conditions and medical complications during their initial hospital stay. However, functional improvement during inpatient rehabilitation was associated with a reduced readmission rate. This study demonstrates that there is a high readmission rate even after the first year post-stroke. It also highlights the importance of rehabilitation in reducing readmission in stroke survivors.
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