mohamed2015.pdf - ORIGINAL ARTICLE Which Comorbidities and Complications Predict Ischemic Stroke Recovery and Length of Stay Wazim Mohamed MD Pratik

mohamed2015.pdf - ORIGINAL ARTICLE Which Comorbidities and...

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Which Comorbidities and Complications Predict IschemicStroke Recovery and Length of Stay? Wazim Mohamed, MD, Pratik Bhattacharya, MD, MPH, Lakshmi Shankar, MD,Seemant Chaturvedi, MD, FAHA, FAAN, and Ramesh Madhavan, MD, DMObjectives:Stroke is the second most common cause of deathworldwide and can lead to significant disability and long-term costs.Length of stay (LOS) is the most predictive factor in determininginpatient costs. In the present study, factors that affect disability andLOS among ischemic stroke patients admitted to an urban communityhospital and 2 university-based teaching hospitals were assessed.Methods:Data for consecutive patients with acute ischemic strokeswere collected, by reviewing discharge diagnosis International Clas-sification of Diseases codes. A data mining process was used to ana-lyze admission data. Data regarding comorbidities and complicationswere abstracted by mining the secondary diagnoses for their respectiveInternational Classification of Diseases-9 codes. The primary outcomewas LOS, calculated from the dates of admission and dates of dis-charge. The second outcome of interest was disability, which wasevaluated by the modified Rankin score at the time of discharge.Results:LOS progressively increased with greater disability. Greaterage and higher National Institute of Health Stroke Scale at admissionwere associated with both higher disability and longer LOS. Presenceof congestive heart failure or chronic kidney disease, atrial fibrillation,other arrhythmias (preexisting or new onset), and development of acuterenal failure were associated with greater LOS but not greater dis-ability status. Patients with a previous stroke and those that developedurinary tract infection as a complication had higher disability.Conclusions:Greater age and higher National Institute of HealthStroke Scale at admission were associated with both higher disabilityand longer LOS. Congestive heart failure, CRF, presence of arrhyth-mias, and development of acute renal failure were associated withgreater LOS. The development of urinary tract infection caused higherdisability.Key Words:ischemic stroke outcomes, length of stay, disability,comorbidities, stroke complications(The Neurologist2015;20:27–32)Stroke is the second most common cause of death worldwideafter ischemic heart disease.1The 2011, WHO updatereports >6 million deaths per year because of stroke.2Thisdisease leads to significant disability and long-term compli-cations with estimated direct and indirect cost to be 73.7 bil-lion dollars in 2010.3The cost incurred is highly variable anddepends on complications during inpatient, rehabilitation, andnursing home stay. Among the different variables, length of4In an effort to reduce health care costs, health careproviders have been using different strategies to reduce lengthof stay (LOS).Infections which include urinary tract infections (UTI)and pneumonia is present in about 15% to 26% of ischemicstroke during the initial 7 days.5,6These complications alongwith congestive heart failure (CHF) significantly prolong theLOS in acute stroke patients,7however, the influence of dif-ferentcomplicationsondisabilityinthesepatientsisunclear.5,6Centers for Medicare and Medicare Service along withThe Joint Commission have taken an active role in promotingquality improvement programs that strive to decrease pre-ventable complications in stroke patients to reduce disabilityand mortality rates, limit LOS, and improve quality of life.In the present study, we explored a large group ofischemic stroke patients admitted to our institution to deter-mine preventable factors that prolong LOS and associated withincreased disability. Knowledge of such factors may helpchannel resources toward preventing these complications.METHODSCase AscertainmentThis retrospective study was approved by the commonInstitutional review board of the 3 affiliated participating hos-pitals. By reviewing discharge International Classification ofDiseases (ICD) codes, data for consecutive patients admitted toan urban community hospital and 2 university-based teachinghospitals for the duration of 20 months (December 2005 to July2007) were collected. Case ascertainment was based on codingdata, and included patients with a primary diagnosis-relatedgroup (DRG) of 14 (intracranial hemorrhage or stroke withinfarct). The study included patients with a diagnosis of ischemicstroke. Patients with hemorrhagic stroke (ICD-9 code: 430, 431,and 432) were excluded from the analysis.Data CollectionA data mining process Healthcare Smartgrid (Process proxyInc., Ellwood city, PA) was used to analyze data such as historyand physicals, consultations, discharge summaries, coding data inpatient stay is the most predictive factor in determining inpatient costs, explaining 72% to 82% of the variations in cost.
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  • Summer '18
  • ischemic stroke, Wolters Kluwer Health

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