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

IF 0.9 Q4 CLINICAL NEUROLOGY

Neurohospitalist Pub Date : 2025-02-25 DOI:10.1177/19418744251323639

Carl M Porto, Dylan N Wolman, Joshua R Feler, Carlin C Chuck, Gnaneswari Karayi, Radmehr Torabi, Krisztina Moldovan, Karen L Furie, Ali Mahta

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Abstract

Background and purpose: Aneurysmal subarachnoid hemorrhage (aSAH) carries high morbidity and mortality with survivors often requiring extended care at skilled nursing facilities (SNF). Predictors of SNF discharge to home (SNFdcH) remain unclear.

Methods: Retrospective review of a single-center prospectively maintained aSAH database from June 2016-March 2024 was conducted. Patients discharged to SNF were grouped by subsequent discharge to home. Predictors of discharge to home and facility length of stay (LOS) were determined using t-tests, Fisher analyses, and cumulative link modeling.

Results: Of 450 aSAH patients, 61 (13.5%) were discharged to SNFs. 49 (80.3%) returned home, with 61% achieving mRS <3 at discharge. Discharged patients were younger (mean 63.3 ± 11.5 vs 70.2 ± 9.3 years, P = .040) with lower median modified Fisher scores (3 [IQR 3-4] vs 4 [4-4], P = .046). Tracheostomy (OR = .14, 95% CI [.02, .75], P = .023) and gastrostomy tube (PEG) placement (OR = .13, 95% CI: .03-.51, P = .003) decreased the odds of SNFdcH. Discharged patients had shorter hospital LOS (26 ± 10 vs 39 ± 15 days, P < .001) and lower median modified Rankin scores (mRS) at hospital discharge (4 [4-5] vs 5 [4-5], P = .028) and at 90 days post-discharge (4 [3-5] vs 6 [5-6], P = .001). Multivariable regression identified age, PEG, and hospital LOS as predictors of SNFdcH. Tracheostomy and PEG predicted SNF LOS.

Conclusions: Most aSAH patients discharged from SNFs returned home, with 61% achieving mRS <3. Patients not discharged were medically complex with neurological deficits. These findings may guide care discussions and highlight the role of SNFs in bridging hospitalization and independence.

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动脉瘤性蛛网膜下腔出血后熟练护理机构住院和出院时间的预测因素。

背景和目的：动脉瘤性蛛网膜下腔出血（aSAH）具有很高的发病率和死亡率，幸存者通常需要在专业护理机构（SNF）进行长期护理。SNF回家排放（SNFdcH）的预测因素仍不清楚。方法：回顾性分析2016年6月至2024年3月间单中心前瞻性维护的aSAH数据库。出院到SNF的患者按随后出院回家分组。使用t检验、Fisher分析和累积关联模型确定了出院和住院时间（LOS）的预测因子。结果：450例aSAH患者中，61例（13.5%）出院至snf。49例（80.3%）返回家中，其中61%达到mRS P = 0.040)，修正Fisher评分中位数较低（3 [IQR 3-4] vs 4 [4-4], P = 0.046）。气管切开术(OR = 0.14, 95% CI[。[02, .75], P = .023)和胃造口管（PEG）放置(OR = .13, 95% CI: .03-。51, P = .003)降低了SNFdcH的几率。出院患者的住院LOS较短（26±10天vs 39±15天，P < 0.001），出院时修正Rankin评分中位数（mRS）较低（4 [4-5]vs 5 [4-5], P = 0.028），出院后90天（4 [3-5]vs 6 [5-6], P = 0.001）。多变量回归确定年龄、PEG和医院LOS为SNFdcH的预测因子。气管切开术和PEG预测SNF LOS。结论：大多数从snf出院的aSAH患者返回家中，61%的患者实现了mRS

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来源期刊

Neurohospitalist CLINICAL NEUROLOGY-

CiteScore

1.60

自引率

0.00%

发文量

108