, Department of Neurological Surgery, Rutgers New Jersey Medical School Newark, New Jersey, United States
Introduction: Acute ischemic strokes account for the most common cerebrovascular accidents leading to high disability and mortality. In this study, we identify the risk factors and comorbidities associated with increased mortality in patients with acute ischemic stroke and the effects it has on inpatient hospital course.
Methods: The 2016 to 2020 National Inpatient Sample (NIS) was used to identify adult inpatients with a primary diagnosis of acute ischemic stroke. Univariate and multivariable analyses adjusting for patient demographics and comorbidity status were used to characterize statistical associations with disease-related complications.
Results: A total of 3,184,309 patients were identified as having acute ischemic stroke from 2016 to 2020. Most patients were over the age of 60 (76%) and 50.4% were males. The majority of patients were white (68.2%) followed by black (17.4%), Hispanic (8.2%), and other (6.2%). Medicare (64.9%) followed by private insurance (19%) and Medicaid (9.4%) were the main primary payers used by patients. Patients who had a malignancy (Odds Ratio [OR]:1.58, 95% Confidence Interval [CI]:1.55-1.61, p < .001), anemia (OR:1.29, CI:1.27-1.31,p < .001), coagulation disorders/deficiencies (OR:1.9, CI:1.86-1.94, p < .001) and identified as other ethnicity (OR:1.12, CI:1.09-1.14, p < .001) had an increase in mortality. Coagulation disorders were associated with increased length of stay (7.26±0.024 days vs. 4.87±0.01 days,p < .001), increased total costs ($102,968.09±370.53 vs. $64,980.03±49.22, p < .001), increased number of procedures (1.96±0.01 vs. 1.08±0.001,p < .001), increased number of days from admission to first procedure (2.31±0.01 vs. 1.74±0.003,p < .001), and increased mortality (8.1% vs. 3.7%, p < .001). Anemia was associated with increased length of stay (7.29±0.015 days vs. 4.62±0.004 days, p < .001), increased total costs ($96,289.28±203.62 vs. $62,117.00±47.971, p < .0001), increased number of procedures (1.87±0.004 vs. 1.00±0.001, p < .001), increased number of days from admission to first procedure (2.47±0.009 vs. 1.62±0.003, p < .001), and increased mortality (5.5% vs. 3.7%, p < .001).
Conclusion : In patients with acute ischemic stroke, anemia and coagulation disorders are associated with an increased complicated hospital course and mortality.
