Abstract TP287: Prolongation of Hospital Stay Following Acute Ischemic Stroke
Introduction: Prolonged length of stay (pLOS) is associated with increased costs and risk for hospital-acquired conditions as well as worse prognosis. Awareness of risk factors for pLOS may help neurohospitalists reduce LOS by heighted preventative measures..
Hypothesis: Admission information and hospital course may help predict pLOS, and this directly correlates with functional outcome.
Design/Methods: Patients with acute ischemic stroke (AIS) admitted to our center between 7/2008-12/2010 were retrospectively identified. Exclusion criteria were presentation >48hrs since last seen normal (LSN) and unknown time of LSN. pLOS was defined as hospitalization extended for ≥24 hours more than would be necessary to prepare the patient for discharge as determined by review of progress notes. Causes of pLOS were categorized as follows: neurological complications, medical complications (included hospital-acquired infections), imaging, procedures, and disposition. We investigated admission data elements associated with pLOS.
Results: Of the 596 patients included, 190 (31.9% of patients) had pLOS. Patients with pLOS were more likely to have hypertension (83.8% vs. 71.8%, p=0.0033) and higher admission NIHSS (8 vs. 5, p=0.0002) than patients without pLOS. LOS was prolonged for >1 reason in 40 (60.6%) cases. The most common reason for pLOS was a medical complication (61.6%), followed by delays in disposition arrangement in nearly half (45.3%).A larger proportion of patients with pLOS developed an infection (37.4% vs. 18.4%, p<0.0001). A larger proportion of patients with pLOS were discharged to inpatient rehabilitation (42.3% vs. 24.2%, p<0.0001) and skilled nursing facilities (9.6% vs. 5.0%, p=0.0387) while a smaller proportion were discharged to home (32.7% vs. 52.5%, p<0.0001).
Conclusions: In our population, a large percentage of patients who suffer from AIS are hospitalized for periods longer than necessary. Major reasons for pLOS are hospital-acquired infection and delayed disposition. Because pLOS increases the risks of hospital-acquired infection and deconditioning, and it consumes more healthcare dollars, it is important to minimize the risk of infection and plan patient disposition early during hospitalization.
- © 2012 by American Heart Association, Inc.