OBJECTIVES:

Stroke is one of the leading causes of morbidity and mortality among adults in the United States (US), with ~87% of stroke cases being acute ischemic stroke (AIS). This study evaluated trends in discharge status, mortality, length of stay (LOS), and 1-year all-cause readmission rate among patients with AIS.

METHODS:

Using Premier Healthcare Database, which includes discharge-level data from roughly 700 hospitals in the US, patients aged ≥18 years with an inpatient admission with a primary diagnosis (ICD-9-CM 433.xx, 434.xx, 436 and ICD-10-CM equivalents) of AIS were identified from January 1, 2011-September 30, 2017. The first admission during the study period was considered as index admission. Index admission outcomes including discharge status and mortality, and length of stay (LOS) were studied. One-year inpatient readmission rates were examined, with the limitation that readmissions in Premier database can only be assessed if patients are readmitted to the same hospital. Trends in outcomes were examined for significance using the Mann-Kendall test for trends.

RESULTS:

The final sample included 505,824 patients with AIS. The average age was 70 years. Almost half were female, and 69.5% were white. A significant decrease in mortality, from 3.86% in 2011 to 3.18% in 2017 (p<0.01) was observed among AIS patients. The average LOS among AIS patients also decreased significantly from 5.46 days in 2011 to 5.11 days 2017 (p<0.01). One-year all-cause inpatient readmission rates decreased significantly from 30.83% in 2011 to 27.40% in 2016Q3 (p<0.01).

CONCLUSIONS:

Significant improvements in mortality, LOS, and readmission rate were observed among AIS patients in our study. To what extent the outcomes improvement observed among AIS patients was contributed by the innovation in treatment modalities remains to be seen.