• Hormuzdiyar H Dasenbrock, Frederico Angriman, Timothy R Smith, William B Gormley, Kai U Frerichs, M Ali Aziz-Sultan, and Rose Du.
• From the Cushing Neurosurgical Outcomes Center, Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (H.H.D., T.R.S., W.B.G., K.U.F., M.A.A.-S., R.D.); and T. H. Chan School of Public Health, Harvard University, Boston, MA (H.H.D., F.A.).
• Stroke. 2017 Sep 1; 48 (9): 2383-2390.

Background And PurposeThe goal of this nationwide study is to evaluate the suitability of readmission as a quality indicator in the aneurysmal subarachnoid hemorrhage (SAH) population.MethodsPatients with aneurysmal SAH were extracted from the Nationwide Readmission Database (2013). Multivariable Cox proportional hazard regression was used to evaluate predictors of a 30-day readmission, and multivariable linear regression was used to analyze the association of hospital readmission rates with hospital mortality rates. Predictors screened included patient demographics, comorbidities, severity of SAH, complications from the SAH hospitalization, and hospital characteristics.ResultsThe 30-day readmission rate was 10.2% (n=346) among the 3387 patients evaluated, and the most common reasons for readmission were neurological, hydrocephalus, infectious, and venous thromboembolic complications. Greater number of comorbidities, increased severity of SAH, and discharge disposition other than to home were independent predictors of readmission (P≤0.03). Although hydrocephalus during the SAH hospitalization was associated with readmission for the same diagnosis, other readmissions were not associated with having sustained the same complication during the SAH hospitalization. Hospital mortality rate was inversely associated with hospital SAH volume (P=0.03) but not significantly associated with hospital readmission rate; hospital SAH volume was also not associated with SAH readmissions.ConclusionsIn this national analysis, readmission was primarily attributable to new medical complications in patients with greater comorbidities and severity of SAH rather than exacerbation of complications from the SAH hospitalization. Additionally, hospital readmission rates did not correlate with other established quality metrics. Therefore, readmission may be a suboptimal quality indicator in the SAH population.© 2017 American Heart Association, Inc.

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