Dataset Information

Risk of ischemic stroke after discharge from inpatient surgery: Does the type of surgery matter?

ABSTRACT: OBJECTIVE:Stroke is a well-known and devastating complication during the perioperative period. However, detailed stroke risk profiles within 90 days in patients discharged without stroke after inpatient surgery are not fully understood. Using the case-crossover design, we aimed to evaluate the risk of ischemic stroke in these patients. METHODS:We included adult patients with the first hospitalization for ischemic stroke between 2011 and 2012 from 23 million enrollees in the National Health Insurance Research Database. Admission date of the hospitalization was defined as the case day and exactly 365 days before the admission date as the control day. The exposure was the last hospitalization for surgery within 1-30, 31-60, or 61-90 days (case period) before the case day or similar time intervals (control period) before the control day. Surgical types were grouped based on the International Classification of Diseases procedure codes. We performed conditional logistic regression adjusting for time-varying variables to determine the relationship between surgery and subsequent stroke, and case-time-control analyses to examine whether the results were confounded by the time-trend in surgery. RESULTS:A total of 56596 adult patients (41% female, mean age 69 years) comprised the study population. After adjustment was made for confounding variables, an association between stroke and prior inpatient surgery within 30 days was observed (adjusted odds ratio 1.44; 95% confidence interval 1.29-1.61). Cardiothoracic, vascular, digestive surgery, and musculoskeletal surgery within 30 days independently predicted ischemic stroke in the case-crossover analysis. In the case-time-control analysis, inpatient surgery remained an independent risk factor for ischemic stroke, whereas only cardiothoracic, vascular, and digestive surgery independently predicted ischemic stroke. CONCLUSIONS:Surgery as a whole independently increased the risk of ischemic stroke within 30 days. Among various types of surgery, cardiothoracic, vascular, and digestive surgery significantly increased the risk of ischemic stroke.

SUBMITTER: Hsieh CY

PROVIDER: S-EPMC6218083 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Risk of ischemic stroke after discharge from inpatient surgery: Does the type of surgery matter?

Hsieh Cheng-Yang CY Huang Chin-Wei CW Wu Darren Philbert DP Sung Sheng-Feng SF

PloS one 20181105 11

<h4>Objective</h4>Stroke is a well-known and devastating complication during the perioperative period. However, detailed stroke risk profiles within 90 days in patients discharged without stroke after inpatient surgery are not fully understood. Using the case-crossover design, we aimed to evaluate the risk of ischemic stroke in these patients.<h4>Methods</h4>We included adult patients with the first hospitalization for ischemic stroke between 2011 and 2012 from 23 million enrollees in the Nation ...[more]

PMID: 30395587

Similar Datasets

Project description:Importance:As prospective payment transitions to bundled reimbursement, many US hospitals are implementing protocols to shorten hospitalization after major surgery. These efforts could have unintended consequences and increase overall surgical episode spending if they induce more frequent postdischarge care use or readmissions. Objective:To evaluate the association between early postoperative discharge practices and overall surgical episode spending and expenditures for postdischarge care use and readmissions. Design, Setting, and Participants:This investigation was a cross-sectional cohort study of Medicare beneficiaries undergoing colectomy (189?229 patients at 1876 hospitals), coronary artery bypass grafting (CABG) (218?940 patients at 1056 hospitals), or total hip replacement (THR) (231?774 patients at 1831 hospitals) between January 1, 2009, and June 30, 2012. The dates of the analysis were September 1, 2015, to May 31, 2016. Associations between surgical episode payments and hospitals' length of stay (LOS) mode were evaluated among a risk and postoperative complication-matched cohort of patients without major postoperative complications. To further control for potential differences between hospitals, a within-hospital comparison was also performed evaluating the change in hospitals' mean surgical episode payments according to their change in LOS mode during the study period. Exposure:Undergoing surgery in a hospital with short vs long postoperative hospitalization practices, characterized according to LOS mode, a measure least sensitive to postoperative outliers. Main Outcomes and Measures:Risk-adjusted, price-standardized, 90-day overall surgical episode payments and their components, including index, outlier, readmission, physician services, and postdischarge care. Results:A total of 639?943 Medicare beneficiaries were included in the study. Total surgical episode payments for risk and postoperative complication-matched patients were significantly lower among hospitals with lowest vs highest LOS mode ($26?482 vs $29?250 for colectomy, $44?777 vs $47?675 for CABG, and $24?553 vs $27?927 for THR; P?<?.001 for all). Shortest LOS hospitals did not exhibit a compensatory increase in payments for postdischarge care use ($4011 vs $5083 for colectomy, P?<?.001; $6015 vs $6355 for CABG, P?=?.14; and $7132 vs $9552 for THR, P?<?.001) or readmissions ($2606 vs $2887 for colectomy, P?=?.16; $3175 vs $3064 for CABG, P?=?.67; and $1373 vs $1514 for THR, P?=?.93). Hospitals that exhibited the greatest decreases in LOS mode had the highest reductions in surgical episode payments during the study period. Conclusions and Relevance:Early routine postoperative discharge after major inpatient surgery is associated with lower total surgical episode payments. There is no evidence that savings from shorter postsurgical hospitalization are offset by higher postdischarge care spending. Therefore, accelerated postoperative care protocols appear well aligned with the goals of bundled payment initiatives for surgical episodes.

Dataset Information

Risk of ischemic stroke after discharge from inpatient surgery: Does the type of surgery matter?

Publications

Risk of ischemic stroke after discharge from inpatient surgery: Does the type of surgery matter?

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets