30 Days Unplanned Readmission (30-Dr) In Cerebral Vein Thrombosis: Us National Retrospective Analysis

Introduction: Thrombosis of the cerebral veins and/or dural sinuses (CVST) results in 0.5% to 1% of all strokes. CVST has a lower mortality rate compared to arterial stroke; however it predisposes to certain complications, which lead to frequent hospital readmissions. Objective: To study the readmission rate, reasons for readmissions and predictors of intracranial hemorrhage (ICH). Method: Using the Nationwide Readmission Database (NRD) from 2013 -2014 patients with a primary discharge diagnosis of CVST (ICD 9 CM code: 437.6, 325, and 671.5) were identified. Their post-hospitalization course was tracked using the variable “NRD_visitlink,” and the time between re-admissions was calculated by subtracting the variable “NRD_DaysToEvent”. SAS 9.4 was used for data analysis with categorical and continuous variables tested using the Rao Scott Chi-square test and Student’s t-test, respectively. Multivariate logistic regression models were used for categorical dependent variable. Result: A total of 3,611 (weighted) Index discharges of CVST were identified. After excluding elective readmissions, 11.32%, 17.04% and 21.81% were the observed readmission rates at 30, 90 and 180 day-follow-up periods respectively. The common causes of 30-day readmission (30-DR) were complications of the puerperium (8.76%), ICH (6.13%), migraine (4.23%), ischemic stroke (2.86%), sepsis (2.30%) and hypertensive complications (1.83%). Epilepsy related readmissions were observed only in the 90-day (1.95%) and 180-day (2.51%) follow up periods. The mean 30-DR cost was lower vs. Index admission (Mean ± SE $ 12,439±1139 vs. $ 16314±652; P value <0.0001) while the length of stay (LOS) during readmission was also lower compared to Index LOS (Mean ± SE 5.0±0.4 vs. 6.4±0.2 ;< 0.0001). After adjusting age and gender, multivariate predictors of increase risk of ICH readmission were hypertension (OR 4.79 CL 1.38-16.59; P=0.0068), primary hypercoagulable state (OR 3.34, CL 1.12-9.99; P=0.0306), meningitis (OR 17.77 CL 2.51-125.96, P=0.0041) and chronic kidney disease (OR 3.80CL 1.04-13.85, P=0.0434). Conclusion: Puerperal complications, ICH, epilepsy and sepsis are the most common complications prompting re-hospitalization in patients diagnosed with CVST.