Impact of Readmission Hospital Site on Outcomes in Patients With Intracerebral Hemorrhage Undergoing Surgery: A Nationwide Cohort Study.

BACKGROUND

Patients with intracerebral hemorrhage who undergo major neurosurgical procedures are at high risk for complications and early readmission. This study aimed to evaluate the association between readmission hospital site (index versus nonindex hospital) and patient outcomes.

METHODS

Using the 2016 to 2020 Nationwide Readmissions Database, we identified patients with intracerebral hemorrhage who underwent major neurosurgical procedures. The outcomes were discharge to home, in-hospital mortality, subsequent readmission, length of stay, and hospitalization costs. After selecting covariates with the least absolute shrinkage and selection operator, we applied Fine-Gray competing-risks models for discharge to home, Cox proportional hazards models for in-hospital mortality, and multivariable linear/logistic models for costs, length of stay, and subsequent readmission.

RESULTS

Among 7149 patients readmitted within 90 days after surgery, 63.9% were readmitted to index hospitals and 36.1% were readmitted to nonindex hospitals. Readmissions to index hospital were associated with a higher likelihood of discharge to home (subdistribution hazard ratio, 1.21 [95% CI, 1.04-1.41]; P=0.013) and lower hospitalization costs (β=-58 588 [95% CI, -86 359 to -30 816]; P<0.001). In-hospital mortality, length of stay, and subsequent readmission rates did not differ significantly between groups.

CONCLUSIONS

In this nationally representative cohort of patients with intracerebral hemorrhage undergoing major neurosurgical procedures, readmission to index hospital within 90 days is associated with higher likelihood of home discharge and lower costs. This pattern may reflect differences in continuity of information, hospital resources, and cross-hospital care coordination, and suggests several potential targets for future system-level improvement, including interoperable electronic health records, imaging access, tele-neurocritical consultation, structured return pathways, and regional rehabilitation integration.