Readmissions after intracerebral hemorrhage often related to infection, study finds

Of 24,540 index intracerebral hemorrhage admissions in the study, 14.5% had an unplanned readmission, and 22% of those had a primary diagnosis code related to infection.

Most 30-day readmissions after hospitalization for intracerebral hemorrhage are related to infection, according to a recent study.

Researchers performed a retrospective cohort study of patients who were discharged from nonfederal acute care hospitals in California between 2006 and 2010 with a primary diagnosis of intracerebral hemorrhage. Patients who died during the index admission, who were discharged against medical advice, or who did not live in California were excluded. The study's main outcome was unplanned readmission within 30 days for an ICD-9-CM code related to infection. The study results were published online June 14 by Stroke.

Of 24,540 index intracerebral hemorrhage admissions during the study period, 3,550 (14.5%) had an unplanned readmission. Of this 3,550, 777 (22%) had a primary diagnosis code related to infection. After all primary and secondary diagnosis codes were evaluated, infection was determined to be associated with 1,826 (51%) of readmissions. Other common readmission reasons were stroke-related codes and aspiration pneumonitis (23.7% and 4.3%, respectively). For infection, the most common codes were septicemia (11.8%), pneumonia (3.5%), urinary tract infection (4.0%), and gastrointestinal infection (1.2%).

Patients readmitted with an infection had higher in-hospital mortality rates than patients with other reasons for readmission (15.6% vs. 8.0%; P<0.001), with a relative risk of 1.7 (95% CI, 1.3 to 2.2) after the authors controlled for other predictors of mortality, such as age and insurance status. Older patients, patients with more comorbid conditions, and patients whose index hospital stays were longer were more likely to have primary infection-related ICD-9-CM codes on readmission.

The researchers noted that they used only ICD-9-CM codes to identify patients with intracerebral hemorrhage and that they could not determine if any patients died out of the hospital, among other limitations. However, they concluded that infections are associated with most 30-day readmissions to acute care hospitals after intracerebral hemorrhage.

“Our findings suggest the need for improved post-discharge infection prevention in the outpatient and immediate care setting, including adoption of best practices for tracheostomy and wound care, aspiration precautions, continued mobilization, and other infection prevention measures,” they wrote. “Patients with advanced age, medical comorbidities, and longer index admission lengths of stay should specifically be targeted given our finding that they are more likely to be readmitted with infection.”