Advanced Age and Post-Acute Care Outcomes After Subarachnoid Hemorrhage

作者：Fehnel Corey R; Gormley William B; Dasenbrock Hormuzdiyar; Lee Yoojin; Robertson Faith; Ellis Alexandra G; Mor Vincent; Mitchell Susan L

来源：Journal of the American Heart Association, 2017, 6(10): e006696.

DOI：10.1161/JAHA.117.006696

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<jats:title>Background</jats:title>
<jats:p xml:lang="en">
Older patients with aneurysmal subarachnoid hemorrhage (
<jats:styled-content style="fixed-case">aSAH</jats:styled-content>
) are unique, and determinants of post–acute care outcomes are not well elucidated. The primary objective was to identify hospital characteristics associated with 30‐day readmission and mortality rates after hospital discharge among older patients with
<jats:styled-content style="fixed-case">aSAH</jats:styled-content>
.
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</jats:sec>
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<jats:title>Methods and Results</jats:title>
<jats:p xml:lang="en">
This cohort study used Medicare patients ≥65 years discharged from
<jats:styled-content style="fixed-case">US</jats:styled-content>
hospitals from January 1, 2008, to November 30, 2010, after
<jats:styled-content style="fixed-case">aSAH</jats:styled-content>
. Medicare data were linked to American Hospital Association data to describe characteristics of hospitals treating these patients. Using multivariable logistic regression to adjust for patient characteristics, hospital factors associated with (1) hospital readmission and (2) mortality within 30 days after discharge were identified. A total of 5515 patients ≥65 years underwent surgical repair for
<jats:styled-content style="fixed-case">aSAH</jats:styled-content>
in 431 hospitals. Readmission rate was 17%, and 8.5% of patients died within 30 days of discharge. In multivariable analyses, patients treated in hospitals with lower annualized
<jats:styled-content style="fixed-case">aSAH</jats:styled-content>
volumes were more likely to be readmitted 30 days after discharge (lowest versus highest quintile, 1–2 versus 16–30 cases; adjusted odds ratio, 2.10; 95% confidence interval, 1.56–2.84). Patients treated in hospitals with lower annualized
<jats:styled-content style="fixed-case">aSAH</jats:styled-content>
volumes (lowest versus highest quintile: adjusted odds ratio, 1.52; 95% confidence interval, 1.05–2.19) had a greater likelihood of dying 30 days after discharge.
</jats:p>
</jats:sec>
<jats:sec xml:lang="en">
<jats:title>Conclusions</jats:title>
<jats:p xml:lang="en">
Older patients with
<jats:styled-content style="fixed-case">aSAH</jats:styled-content>
discharged from hospitals treating lower volumes of such cases are at greater risk of readmission and dying within 30 days. These findings may guide clinician referrals, practice guidelines, and regulatory policies influencing which hospitals should care for older patients with
<jats:styled-content style="fixed-case">aSAH</jats:styled-content>
.
</jats:p>
</jats:sec>

• 出版日期2017-10