Predictors of Skilled Nursing Facility Length of Stay and Discharge After Aneurysmal Subarachnoid Hemorrhage
Gnaneswari Karayi1, Carl Porto1, Dylan Wolman2, Joshua Feler3, Carlin Chuck3, Radmehr Torabi4, Krisztina Moldovan5, Karen Furie6, Ali Mahta7
1Warren Alpert School, Warren Alpert School of Medicine, 2Diagnostic Imaging, , Rhode Island Hospital, The Warren Alpert School of Medicine at Brown University, 3Neurosurgery, Rhode Island Hospital, The Warren Alpert School of Medicine at Brown University, 4Neurosurgery, Rhode Island Hospital, 5Rhode Island Hospital, 6Neurology, RIH/Alpert Medical School of Brown Univ, 7Neurology/Neurosurgery, Brown University
Objective:
This study aimed to identify predictors of discharge from extended care facilities (ECF) to home in aSAH patients.
Background:
Aneurysmal subarachnoid hemorrhage (aSAH) carries high morbidity and mortality. Survivors often require extended care at skilled nursing facilities (SNF) or long-term acute care centers (LTAC).
Design/Methods:
Retrospective review of database of aSAH patients treated at a single center was conducted. Included patients were discharged from hospital to ECF. Patients discharged to ECF were grouped by discharge status, and estimated facility length of stay (LOS) was determined. Demographics, aSAH characteristics, hospital complications, and post-aSAH neurological status were analyzed. Predictors of ECF discharge were analyzed using t-tests, Fisher analyses, and multivariable logistic regression. Cumulative link modeling identified facility LOS predictors.
Results:
Of 450 aSAH patients, 61 (13.5%) were discharged to SNF. 49 (80.3%) SNF patients were discharged home. Discharged patients were younger (mean 63.3±11.5 years vs. 70.2±9.3, p=0.040), and had lower modified Fisher scores (3 [IQR 3-4] vs. 4 [IQR 4-4], p=0.046). Intraventricular hemorrhage (OR 0, 95% CI 0-1.12, p=0.043), tracheostomy (OR=0.14, 95% CI 0.14-1.01, p=0.048), and percutaneous gastrostomy tube (PEG) placement (OR=0.13, 95% CI 0.03-0.51, p=0.003) were associated with lower odds of SNF discharge. Patients discharged had lower mRS scores at hospital discharge (4 [IQR 4-5] vs. 5 [IQR 4-5], p=0.028) and 90-days post-discharge (4 [IQR 3-5] vs. 6 [IQR 5-6], p=0.001). Multivariable regression identified old age, PEG and hospital LOS as independent predictors of home discharge from SNF. Tracheostomy, PEG, and symptomatic vasospasm predicted SNF LOS.
Conclusions:
Most aSAH patients were discharged from SNF to home. Those not discharged were medically complex with neurological deficits. These results may guide goals of care discussions as SNF placement may bridge hospitalization and independence.
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