Abstract TMP94: Complications Are Frequent In The First Month After Hospital Discharge For Stroke And Are Associated With Worse Functional Outcomes
Data are growing on medical complications that occur during hospitalization for stroke and on readmission rates, although little is known of complications not resulting in readmission nor their impact on functional outcomes. We performed a comprehensive evaluation of complications occurring in the first month following hospital discharge for stroke and their association with functional outcomes
Methods: Prospective cohort study of patients admitted for stroke at 6 hospitals participating in the Ohio Coverdell Outcomes Evaluation Project. Hospital-based data was obtained from chart abstraction. Postdischarge information was obtained by phone (5 hosp) or postdischarge visits (1 hosp). Patients who died or had hospice care prior to discharge were excluded.
Results: Follow-up information 30-51days postdischarge was available in 378 of 573 patients. Mean age was 68.6 and admit NIHSS was 3.9. Death occurred < 30d postdischarge in 3.2% (n=12) and unplanned readmission < 30d occurred in 9.6% (n=35) of patients alive through f/u. Most common reasons for readmission were cardiovascular (19.5%, 8/41). Complications not requiring readmission occurred in 19.4% (n=71); infections (29.6%), falls (18.3%) and cardiovascular issues (1.9%) were most common. Patients who were readmitted had higher rates of hospital UTI (17.1 vs 7.3%, p=.04) and pneumonia (11.4 vs 3.1%, p=.039) and h/o CAD (40.0% vs 23.7%, p=.04), with no differences in dc destination, admit NIHSS, and dc Rankin among other factors. Patients that were readmitted had worse functional outcomes at 1 mo (Rankin 2.8 vs 2.1, p=.001), even after adjustment (p=.02). Patients with complications that were not readmitted had more diabetes (42.2 vs 27.5%, p=0.021) but were otherwise similar to those without. However, their Rankin scores improved less often (42.2 vs 55.6%, p=.04) and they had worse Rankin scores at 30d (2.4 vs 2.1, p=.03) which persisted after adjustment (p=.01).
Conclusion: Medical complications occurred in 26.2% of patients within the 1st month of hospital discharge. Despite similar functional status at discharge, patients with complications, regardless of whether they were readmitted, had worse functional status at 1 mo. Prevention of these complications may lead to improve stroke outcomes.
- © 2012 by American Heart Association, Inc.