Neurology. 2025 May 27;104(10):e213638. doi: 10.1212/WNL.0000000000213638. Epub 2025 May 8.
ABSTRACT
BACKGROUND AND OBJECTIVES: Older adults are expected to have higher readmission rates after seizure-related hospitalization. We sought to define the 30-day readmission rate for older adults after seizure hospitalization and to examine whether occurrence, timing, or specialization of follow-up with primary or neuro-related care is associated with lower readmission risk.
METHODS: This is a retrospective cohort study using 2016-2019 Medicare claims data, including adults aged older than 65 years hospitalized with a primary diagnosis of seizure/epilepsy. The primary outcome was readmission within 30 days. Exposure of interest was presence or absence of follow-up and specialty of the follow-up provider. Beneficiaries were followed from 90 days before admission to 30 days after discharge. We defined variables a priori based on literature/clinical judgment and used a least absolute shrinkage and selection operator (LASSO) method to determine factors that were contributing to the data’s variance for inclusion in the final model.
RESULTS: Of 80,620 beneficiaries with admissions for seizure/epilepsy, 17.72% were readmitted within 30 days. Overall, 20.6% saw only primary care, 2.5% neurology only, 0.3% neurosurgery only, and 0.1% epilepsy only, and 5.4% had a combination of visits. Readmission rates differed by follow-up visit status: 22% readmission rate for those with no follow-up and only 6% with any health care visit. Among those with a visit, the readmission rates by specialty were as follows: 8% for primary care alone, 5% for neurology alone, 16% for neurosurgery alone, 1% for epileptology alone, and 2% for those who had seen a combination of these specialties. In our LASSO-selected multivariable model, outpatient follow-up was associated with lower odds of readmission: early (days 1-15) primary care visit (adjusted odds ratio [aOR] 0.49; 95% CI 0.45-0.52, p < 0.001); early neurology visit (aOR 0.39; 95% CI 0.33-0.46, p < 0.001); and later (days 16-30) neurosurgery visit (aOR 0.42; 95% CI 0.27-0.67, p < 0.001), later neurology visit (aOR 0.16; 95% CI 0.13-0.21, p < 0.001), or later primary care visit (aOR 0.16; 95% CI 0.14-0.17, <0.001), all associated with reduced odds of readmission.
DISCUSSION: We found high rates of readmission in older adults. Outpatient follow-up was associated with reduced odds of readmission. These findings reinforce the importance of discharge planning and suggest that ensuring outpatient follow-up with either primary care or neurology may be an easy intervention to reduce readmissions.
PMID:40340379 | DOI:10.1212/WNL.0000000000213638
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