(1) Characterize patients with all cause 30-day readmission after acute ischemic stroke (IS), (2) identify predictors of post-IS readmission.

Post-stroke readmission unfavorably impacts our patients and the healthcare system. Several studies attribute increased risk of 30-day readmissions to factors including medical comorbidities, stroke severity, and discharge disposition. However, the leading etiologies appear to vary across institutions and remain a moving target. We hypothesized that patients with increased medical complexity, often requiring longer hospitalizations, have higher odds of post-IS 30-day readmission.

We performed a retrospective case-control study analyzing post-IS 30-day readmission between January 2016 – December 2019 using data from the Mount Sinai Hospital’s Get With The Guidelines database. We performed chi square analyses and multivariate adjusted logistic regression model including age, sex, coronary artery disease (CAD), renal insufficiency (RI), history of prior stroke or TIA (CVD), length of stay (LOS) > 7, and NIHSS ≥ 5.

6.7% (n=115) of 1,706 IS patients were readmitted within 30 days. The 115 cases were compared to 1591 controls not readmitted within 30 days. Age and sex were similar in the two groups. Risk factors for 30-day readmission included CAD (34% vs 24%, p=0.02), RI (17% vs 10%, p=0.02), history of prior CVD (42% vs 30%, p=0.01), NIHSS ≥ 5 (60% vs 49%, p=0.04), and LOS > 7 (57% vs 36%, p<0.001). In our adjusted model, CAD (OR=1.7, p=0.01), history of prior CVD (OR=1.6, p=0.01), LOS >7 (OR=1.7, p=0.02), and NIHSS ≥ 5 (OR=4.5, p<0.001) predicted 30-day readmission.

Patients with post-IS 30-day readmission were more likely to have complex medical comorbidities and history of stroke or TIA compared to controls. Patients with more severe stroke and longer length of stay may benefit from individualized transition of care plans and closer follow up to decrease likelihood of readmission during the vulnerable 30-day post stroke period.