Factors associated with post-stroke readmission: a systematic review and meta analysis

Readmissions following strokes are a significant concern due to their association with adverse outcomes. The Centers for Medicare and Medicaid Services regard hospital readmissions as a measure of suboptimal hospital care and have made reducing readmission rates a national healthcare reform goal. This systematic review and meta-analysis aimed to identify factors associated with 30-day, 90-day, and 1-year ischemic stroke readmissions. We reviewed the databases PubMed and Web of Science for English-language studies on stroke readmissions published between January 1, 2000, and February 5, 2024. A total of 135 studies from 18 countries met the inclusion criteria. Higher 30-day readmissions were linked to advanced age, insurance type, employment status, socioeconomic disadvantage, discharge destination, and conditions such as heart failure and diabetes. Reduced 30-day readmissions were associated with effective discharge planning, post-primary care visits, and thrombolytic therapy administration. Weekend admissions and the COVID-19 period were not significant contributing factors. Our meta-analysis on 30-day readmissions in the U.S. found increased odds with atrial fibrillation (OR, 1.24 95% CI, 1.12-1.36), and cancer (OR, 1.50 95% CI, 1.19-1.89), while discharge to home (OR, 0.75 95% CI, 0.55-1.02) and private insurance (OR, 0.70 95% CI, 0.66-0.75) decreased the odds. Advanced age, comorbidities, and discharge planning impacted 90-day readmissions, while 1-year readmissions were influenced by advanced age, discharge location, functional independence, and diseases including diabetes and coronary artery disease. The study highlights the importance of hospital discharge procedures and follow-up care as modifiable factors for mitigating the risk of readmission in stroke patients. Prioritization in care transition enhancements and proper discharge planning for at-risk patients could help improve stroke readmission rates.