Which Comorbidities and Complications Predict Ischemic Stroke Recovery and Length of Stay?

OBJECTIVES: Stroke is the second most common cause of death worldwide and can lead to significant disability and long-term costs. Length of stay (LOS) is the most predictive factor in determining inpatient costs. In the present study, factors that affect disability and LOS among ischemic stroke patients admitted to an urban community hospital and 2 university-based teaching hospitals were assessed.
METHODS: Data for consecutive patients with acute ischemic strokes were collected, by reviewing discharge diagnosis International Classification of Diseases codes. A data mining process was used to analyze admission data. Data regarding comorbidities and complications were abstracted by mining the secondary diagnoses for their respective International Classification of Diseases-9 codes. The primary outcome was LOS, calculated from the dates of admission and dates of discharge. The second outcome of interest was disability, which was evaluated by the modified Rankin score at the time of discharge.
RESULTS: LOS progressively increased with greater disability. Greater age and higher National Institute of Health Stroke Scale at admission were associated with both higher disability and longer LOS. Presence of congestive heart failure or chronic kidney disease, atrial fibrillation, other arrhythmias (preexisting or new onset), and development of acute renal failure were associated with greater LOS but not greater disability status. Patients with a previous stroke and those that developed urinary tract infection as a complication had higher disability.
CONCLUSIONS: Greater age and higher National Institute of Health Stroke Scale at admission were associated with both higher disability and longer LOS. Congestive heart failure, CRF, presence of arrhythmias, and development of acute renal failure were associated with greater LOS. The development of urinary tract infection caused higher disability.