To provide nationwide estimates and a temporal trend for overall, planned, and potentially-preventable 30-day-readmission among ischemic and hemorrhagic stroke patients (SPs). To determine the association between hospitals’ stroke discharge volume (SDV), teaching status and 30-day-readmission. To highlight the causes of 30-day-readmission.

Readmission reduction is linked with improved quality of care, saves cost, and is a desirable patient-centered outcome. Nationally representative readmission metrics for SPs are unavailable.

We performed a year-wise cohort analysis of the national readmission database from January 2010 to September 2015. Adult (≥ 18 years) patients with primary discharge diagnosis of ischemic stroke (IS), intracerebral hemorrhage (ICH), or sub-arachnoid hemorrhage (SAH) were tagged using validated ICD-9 codes. Hospitals were categorized by their annual SDV and were classified as teaching if they had an American Medical Association-approved residency program or had a ratio of full-time equivalent interns / residents to beds of 0.25 or higher. We defined readmission as any admission within 30 days of index hospitalization discharge. Using CMS defined algorithms, events were classified as unplanned and/or potentially-preventable.

Based on our criteria, 2,078,854 eligible patients were included. Mean (SE) age: 70.02 (0.07), and 51.90% female. The overall proportion (95% CI) for 30-day-readmission was highest for ICH patients (13.70%, 13.40 – 13.99), followed by IS (12.44%, 12.33 – 12.55) and SAH patients (11.48%, 11.01 – 11.96). On average there was a 3.3% annual decline in readmission between 2010 and 2014, which was statistically significant (OR, 95% CI: 0.96, 0.95 – 0.97). Patients discharged from non-Teaching hospitals with high SDV were at a significantly higher risk of 30-day-readmission and the top 2 leading causes of readmission were acute cerebrovascular disease and septicemia.