Rate and key predictors of unplanned readmission following ischemic stroke: a systematic review and meta-analysis

Objective To systematically evaluate the rate and risk factors for unplanned readmission in patients with ischemic stroke (IS), providing an evidence-based foundation for developing targeted prevention strategies. Methods We systematically searched PubMed, Web of Science, Embase, Cochrane Library, CNKI, Wanfang, Weipu Data and SinoMed databases for studies on the rate and risk factors of unplanned readmission in IS patients from their inception to July 30, 2025. Two researchers independently conducted literature screening, quality assessment, and data extraction. Meta-analysis was performed. Results A total of 44 studies involving 1,274,267 patients were included. The pooled rate of 30-day readmission was 14.2% (95% CI 11–18%), increasing to 13.9% at 90 days and 30.3% at 12 months, with substantial heterogeneity across studies ( I 2 90%). Readmission rates were lower in North America (11.7%) and higher in Asian settings (17.2%). Atrial fibrillation (OR 1.34), heart failure (OR 1.59), diabetes (OR 1.29), and prior stroke (OR 1.50) were associated with increased likelihood of 30-day readmission. Longer hospital stay (OR 1.03 per unit increase) and greater stroke severity (NIHSS OR 1.13) were also associated with higher readmission risk. Infection (25.1%), recurrent stroke (21.8%), and cardiac events (13.7%) were the most consistently reported causes. Conclusion This meta-analysis clarifies and updates the rate and core risk factors for unplanned readmission in ischemic stroke patients. It provides an evidence-based foundation for systematically identifying high-risk patients, developing risk assessment tools, and implementing targeted interventions, holding significant value for guiding clinical practice. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251157352 , identifier CRD420251157352.