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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Predictors of discharge to home and facility length of stay (LOS) were determined using t-tests, Fisher analyses, and cumulative link modeling.</p><p><strong>Results: </strong>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, <i>P</i> = .040) with lower median modified Fisher scores (3 [IQR 3-4] vs 4 [4-4], <i>P</i> = .046). Tracheostomy (OR = .14, 95% CI [.02, .75], <i>P</i> = .023) and gastrostomy tube (PEG) placement (OR = .13, 95% CI: .03-.51, <i>P</i> = .003) decreased the odds of SNFdcH. Discharged patients had shorter hospital LOS (26 ± 10 vs 39 ± 15 days, <i>P</i> < .001) and lower median modified Rankin scores (mRS) at hospital discharge (4 [4-5] vs 5 [4-5], <i>P</i> = .028) and at 90 days post-discharge (4 [3-5] vs 6 [5-6], <i>P</i> = .001). Multivariable regression identified age, PEG, and hospital LOS as predictors of SNFdcH. Tracheostomy and PEG predicted SNF LOS.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":" ","pages":"19418744251323639"},"PeriodicalIF":0.9000,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11863197/pdf/","citationCount":"0","resultStr":"{\"title\":\"Predictors of Skilled Nursing Facility Length of Stay and Discharge After Aneurysmal Subarachnoid Hemorrhage.\",\"authors\":\"Carl M Porto, Dylan N Wolman, Joshua R Feler, Carlin C Chuck, Gnaneswari Karayi, Radmehr Torabi, Krisztina Moldovan, Karen L Furie, Ali Mahta\",\"doi\":\"10.1177/19418744251323639\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and purpose: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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, <i>P</i> = .040) with lower median modified Fisher scores (3 [IQR 3-4] vs 4 [4-4], <i>P</i> = .046). Tracheostomy (OR = .14, 95% CI [.02, .75], <i>P</i> = .023) and gastrostomy tube (PEG) placement (OR = .13, 95% CI: .03-.51, <i>P</i> = .003) decreased the odds of SNFdcH. Discharged patients had shorter hospital LOS (26 ± 10 vs 39 ± 15 days, <i>P</i> < .001) and lower median modified Rankin scores (mRS) at hospital discharge (4 [4-5] vs 5 [4-5], <i>P</i> = .028) and at 90 days post-discharge (4 [3-5] vs 6 [5-6], <i>P</i> = .001). Multivariable regression identified age, PEG, and hospital LOS as predictors of SNFdcH. Tracheostomy and PEG predicted SNF LOS.</p><p><strong>Conclusions: </strong>Most aSAH patients discharged from SNFs returned home, with 61% achieving mRS <3. Patients not discharged were medically complex with neurological deficits. 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引用次数: 0
摘要
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
Predictors of Skilled Nursing Facility Length of Stay and Discharge After Aneurysmal Subarachnoid Hemorrhage.
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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