Readmission Rates in Stroke Patients with and without Infections: Incidence and Risk Factors

Amelia K Boehme; Maitreyi Oka; Bevin Cohen; Mitchell S V Elkind; Elaine Larson; Barun Mathema

doi:10.1016/j.jstrokecerebrovasdis.2021.106172

Readmission Rates in Stroke Patients with and without Infections: Incidence and Risk Factors

J Stroke Cerebrovasc Dis. 2022 Jan;31(1):106172. doi: 10.1016/j.jstrokecerebrovasdis.2021.106172. Epub 2021 Nov 16.

Authors

Amelia K Boehme¹, Maitreyi Oka², Bevin Cohen³, Mitchell S V Elkind⁴, Elaine Larson⁵, Barun Mathema⁶

Affiliations

¹ Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA. Electronic address: akb2188@cumc.columbia.edu.
² Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
³ School of Nursing, Columbia University, 722 W 168th Street, Room 707, New York, NY 10032, USA. Electronic address: bac2116@cumc.columbia.edu.
⁴ Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY 10032, USA. Electronic address: mse13@cumc.columbia.edu.
⁵ Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; School of Nursing, Columbia University, 722 W 168th Street, Room 707, New York, NY 10032, USA. Electronic address: ell23@cumc.columbia.edu.
⁶ Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA. Electronic address: bm2055@cumc.columbia.edu.

PMID: 34798436
PMCID: PMC8766957
DOI: 10.1016/j.jstrokecerebrovasdis.2021.106172

Abstract

Background: Stroke patients are at increased risk for acquiring infections in the hospital and risk of readmission. We aimed to examine whether an infection acquired during the initial stroke admission contributes to increased risk of readmission and infection during readmission.

Methods: We performed a retrospective cohort study incorporating all adult ischemic stroke patients from three New York City hospitals from 2006 to 2016. A validated computer algorithm defined infections based on electronically-available laboratory culture data. Multivariable logistic regression was used to evaluate the crude and adjusted association of infections present on admission (IPOA) and healthcare-associated infections (HAI) with 60-day readmissions, and infection during readmission.

Results: Among the 10,436 stroke patients, 17% had infections during initial admission of which 52% were IPOA and 48% were HAI. The risk of readmission was significantly higher for those with HAIs (OR = 1.40; 95% CI: 1.20-1.64) and IPOA (OR = 1.26; 95% CI: 1.09-1.47). The presence of infection during the 60-day readmission was also independently predicted by HAI (OR = 3.27; 95% CI: 2.60-4.12) and IPOA (OR = 2.54; 95% CI: 2.01-3.22). Patients with a Gram-negative infection were not at higher odds for readmission compared to patients with a Gram-positive infection (OR 1.07, 95%CI 0.81-1.42).

Conclusion: Among stroke patients, HAI and IPOA were predictors of readmission within 60 days and infection during readmission.

Keywords: Infections; Risk factors; Stroke epidemiology; Stroke outcomes.

MeSH terms

Adult
Cross Infection / epidemiology
Humans
Incidence
Infections* / epidemiology
Patient Readmission* / statistics & numerical data
Retrospective Studies
Risk Factors
Stroke* / therapy

Abstract

MeSH terms

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