Abstract Details

Title Predictors of Skilled Nursing Facility Length of Stay and Discharge After Aneurysmal Subarachnoid Hemorrhage

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P6 - Poster Session 6 (11:45 AM-12:45 PM)

Poster/Presentation
Number 13-011

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.

Authors/Disclosures
Gnaneswari Karayi (Brown University) PRESENTER	Miss Karayi has nothing to disclose.
Carl Porto III	Mr. Porto has nothing to disclose.
Dylan Wolman, MD	Dr. Wolman has nothing to disclose.
Joshua Feler, MD	Dr. Feler has nothing to disclose.
Carlin Chuck	Mr. Chuck has received personal compensation for serving as an employee of Brown University. Mr. Chuck has received research support from NIH (Grant: T35-HL094308).
Radmehr Torabi (Rhode Island Hospital)	Radmehr Torabi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Silk Road Medical.
Krisztina Moldovan	Krisztina Moldovan has nothing to disclose.
Karen L. Furie, MD (RIH/Alpert Medical School of Brown Univ)	The institution of Dr. Furie has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Janssen/BMS. Dr. Furie has received personal compensation in the range of $50,000-$99,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for BMJ/JNNP. The institution of Dr. Furie has received research support from NINDS.
Ali Mahta, MD (Brown University)	Dr. Mahta has received research support from Brown University Health.

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