Candrilli SD, Karve SJ, Wirth PE. Complications arising during hospitalization for hemorrhagic or ischemic stroke: evidence from a large administrative database. Poster presented at the 2011 ISPOR 16th Annual International Meeting; May 25, 2011. [abstract] Value Health. 2011 May; 14(3):A51.

OBJECTIVES: Limited data exist regarding the economic burden of complications arising during stroke-related hospitalizations. This study sought to document the rate of complications arising during hospitalization (i.e., defined as diagnoses recorded upon discharge but not observed at admission) for hemorrhagic (HS) or ischemic stroke (IS), and describe characteristics of complicated hospitalizations.

METHODS: Data for hospitalizations with a primary diagnosis of HS (ICD-9-CM codes 430.xx, 431.xx, or 432.xx) or IS (433.x1, 434.xx, or 436.xx) in the 2008 HCUP Michigan State Inpatient Database were analyzed. Incidence of complications developed during hospitalization among patients with a primary diagnosis of HS or IS were assessed, and resource-based outcomes (e.g., total cost, length of stay [LOS]) among, and other characteristics of, stays with complications, compared to uncomplicated hospitalizations, analyzed.

RESULTS: Of the 1.3 million hospitalizations occurring in Michigan in 2008, 19,065 had a primary diagnosis of HS or IS. Among these, 20.6% (n3,922) had evidence of 1 complications arising during the stay. No differences in patient age (mean: 70.4 versus 70.7 years; p0.3293) or gender distribution (53% versus 54% female; p0.3476) between complicated and uncomplicated hospitalizations were observed. The top-5 most frequently observed complications were urinary tract infection, site not specified; hypopotassemia; acute respiratory failure; pneumonitis due to inhalation of food or vomitus; and acute kidney failure, unspecified. Compared to uncomplicated hospitalizations, mean LOS and total costs for complicated stays were significantly greater: 10.5 versus 4.5 days (p0.0001) and $28,608 versus $10,747 (p0.0001), respectively. Patients with 1 complications spent 2.8 (SD6.4) days in an ICU, and a greater proportion with complications than without died during hospitalization (11.4% versus 6.6%; p0.0001).

CONCLUSIONS: The cost of stroke-related hospitalizations with complications is significant, 3 times greater than stroke-related hospitalizations without complications. Efforts to improve inpatient stroke management strategies may help lower the incidence of complications, reduce associated costs, and improve patient outcomes.

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