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(Stroke. 2000;31:2346.)
© 2000 American Heart Association, Inc.

Original Contributions

Cost and Outcome of Mechanical Ventilation for Life-Threatening Stroke

Stephan A. Mayer, MD; Daphne Copeland, MPH; Gary L. Bernardini, MD, PhD; Bernadette Boden-Albala, MPH; Laura Lennihan, MD; Sharon Kossoff, MS Ralph L. Sacco, MD, MS

From the Department of Neurology (S.A.M., D.C., G.L.B., B.B-A., L.L., S.K., R.L.S.) and the Gertrude H. Sergievsky Center (R.L.S.), Columbia University College of Physicians and Surgeons, and the Divisions of Epidemiology (R.L.S.) and Socio-Medical Science (B.B-A.), Columbia University School of Public Health, New York, NY.

Background and Purpose—Hospital mortality rates of 50% to 90% have been reported for stroke patients treated with mechanical ventilation. These data have raised serious questions about the cost-effectiveness of this intervention. We sought to determine how often stroke patients are mechanically ventilated, identify predictors of 30-day survival among ventilated patients, and evaluate the cost-effectiveness of this intervention.

Methods—We identified mechanically ventilated patients in a population-based multiethnic cohort of 510 incidence stroke patients who were hospitalized between July 1993 and June 1996. Factors affecting 30-day survival were identified in a multiple logistic regression analysis. We calculated the cost per patient discharged alive, life-year saved, and quality-adjusted life-year saved using a zero-cost, zero-life assumption.

Results—Ten percent of patients (n=52) were mechanically ventilated. Thirty-day mortality was 65% overall and did not differ significantly by stroke subtype. Glasgow Coma Scale score on the day of intubation (P<0.01) and subsequent neurological deterioration (P=0.02) were identified as predictors of 30-day mortality. The cost (1996 US dollars) of hospitalization per patient discharged alive was $89 400; the cost per year of life saved was $37 600; and the cost per quality-adjusted life-year saved was $174 200. Functional status of most survivors was poor; at 6 months, half were severely disabled and completely dependent. In a worst-case scenario of quality of life preferences, mechanical ventilation resulted in a net deficit of meaningful survival.

Conclusions—Two thirds of mechanically ventilated stroke patients die during their hospitalization, and most survivors are severely disabled. Survival is particularly unlikely if patients are deeply comatose or clinically deteriorate after intubation. In our multiethnic urban population, mechanical ventilation for stroke was relatively cost-effective for extending life but not for preserving quality of life.

Key Words: cerebrovascular disorders • cost-benefit analysis • critical care • quality of life • stroke outcome • ventilators, mechanical

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