Fatores associados às readmissões hospitalares não planejadas no período de um ano após o acidente vascular cerebral

Abstract

The problems related to the deficits in the transition of care for people who survive stroke and their family caregivers include the frequent and high rates of unplanned hospital readmissions, which are generally due to poor planning of hospital discharge. The objective of this analytical and cross-section study was to analyze the factors associated with unplanned hospital readmissions, in one year, after the stroke. Therefore, 224 medical records of patients hospitalized in 2018 diagnosed with stroke were analyzed at a specialized service in Goiânia, Goiás, Brazil. Data were collected using a structured instrument and analyzed by means of to descriptive and inferential statistics, with multiple logistic regression. Among the 224 hospitalized patients in 2018 who were diagnosed with stroke, 14 (6.25%) died. The final sample consisted of 210 participants. Most were male (118; 56.19%), lived with someone (110; 64.33%) and had a health insurance (198; 94.74%). The median age was 70 years (IIQ = 60-81). Among the participants, 86.19% (n = 181) were victims of ischemic stroke. The median length of the first hospitalization was 4 days (IIQ = 3-7). The majority was discharged to the home (160; 76.19%), and most patients were using anticoagulants (176; 83.81%) and platelet antiaggregants (122; 58.1%). The overall rate of unplanned readmissions in one year due to stroke was 23.81% [95% CI 18.05% - 29.57%], with 7.61% [95% CI 4.03% -11.21% ] in the first month, 5.71% [95% CI 2.57% -8.85%, n = 12] in three months and 10.47% [95% CI 6.33% -14.62%] in one year. The most frequent causes of readmissions were infections (18; 36%) and recurrent strokes (14; 28%). The logistic regression showed that the variables that together best predicted hospital readmission were: number of drugs prescribed at hospital discharge (OR = 1.15 95% CI 1.04-1.29); diabetes (OR = 2.53 95% CI 1.11-5.82); dyslipidemia (OR = 4.08 95% CI 1.54-10.90); atrial fibrillation (OR = 2.39 95% CI 1.00-5.66); coronary artery disease (OR = 3.12 CI 95% 0.84-11.39); peripheral vascular disease (OR = 9.19 95% CI 1.25-81.26); and being discharged with some limitation for activities of daily living (OR = 4.01 95% CI 1.79-9.22). The results indicate the possibility of hospital readmissions after a stroke in people with multiple chronic conditions, using multiple drugs and with some limitation for activities of daily living. These factors need to be taken into account, especially in the advanced planning of hospital discharge and in monitoring the risk for unplanned hospital readmissions