Medical complications of ischemic stroke and length of hospital stay: experience in Seattle, Washington.

BACKGROUND: Medical complications of ischemic stroke can increase length of hospital stay (LOS). Stroke clinical pathways aim to reduce costs by decreasing LOS through standardization of care and avoidance of complications. MATERIALS AND METHODS: Using a population-based, state-mandated, hospital discharge database, we sought to analyze the effects of common medical complications of incident ischemic stroke on LOS in Seattle, Washington from 1990 to 1994. All nonstroke medical complications listed in the discharge diagnoses with a 5% or greater frequency were entered with age and gender into linear regression models. LOS was the dependent variable. RESULTS: The inclusion criteria was met by 4,757 hospitalizations. Congestive heart failure (9.5%), urinary tract infection (9.3%), pneumonia (7.1%), age (mean, 75), and gender (57% female) were all entered into the linear regression models. The presence of congestive heart failure was associated with an increased LOS of 24% (15% to 33%), urinary tract infection of 41% (31% to 51%), and pneumonia of 52% (40% to 65%). Multiplying the increases in LOS by the prevalence of the complications led to estimated LOS savings of 9.8% (7.1% to 12.4%). Pneumonia was associated with an odds ratio of 3.7 (2.8 to 4.8), congestive heart failure 2.0 (1.5 to 2.6), and urinary tract infection 0.6 (0.4 to 0.8) for hospital fatality. CONCLUSIONS: Each complication was associated with large and significant increases in the LOS. The potential LOS savings in these patients may be 10%, if all such complications could be avoided. Associations with increased LOS and risk of in-hospital death indicate a strong need to continue to avoid such medical complications of ischemic stroke.