title: The cost of pneumonia after acute stroke.
abstract: OBJECTIVE
  To determine the incremental costs of pneumonia occurring during hospitalization for stroke.
  
  
  METHODS
  We reviewed hospital records of all Medicare patients admitted for ischemic or hemorrhagic stroke to 29 hospitals in a large metropolitan area, 1991 through 1997, excluding those who died or had do not resuscitate orders written within 3 days of admission. Hospital costs of patients with stroke were determined using Medicare Provider Analysis and Review data after adjustment for baseline factors affecting cost and propensity for pneumonia. Secondary analyses examined the risk-adjusted relationship of pneumonia to discharge disposition.
  
  
  RESULTS
  Pneumonia occurred in 5.6% (635/11,286) of patients with stroke, and was more common among patients admitted from nursing homes and those with greater severity of illness (p < 0.001). Mean adjusted costs of hospitalization for patients with stroke with pneumonia were $21,043 (95% CI $19,698 to 22,387) and were $6,206 (95% CI $6,150 to 6,262) for patients without pneumonia, resulting in an incremental cost of $14,836 (95% CI $14,436 to 15,236). Patients with pneumonia were over 70% more likely to be discharged with requirements for extended care (adjusted OR 1.73, 95% CI 1.32 to 2.26).
  
  
  CONCLUSIONS
  Extrapolated to the over 500,000 similar patients hospitalized for stroke in the United States, the annual cost of pneumonia as a complication after acute stroke is approximately $459 million.
authors.affiliation: Center for Health Care Research & Policy, MetroHealth Medical Center, Cleveland, OH 44109, USA. ikatzan@metrohealth.org
authors.forename: I L
authors.initials: IL
authors.lastname: Katzan
authors.forename: N V
authors.initials: NV
authors.lastname: Dawson
authors.forename: C L
authors.initials: CL
authors.lastname: Thomas
authors.forename: M E
authors.initials: ME
authors.lastname: Votruba
authors.forename: R D
authors.initials: RD
authors.lastname: Cebul
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D005260:Female; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D006278:Medicare; D010043:Outcome and Process Assessment, Health Care; D011014:Pneumonia / Q000191:economics* / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications*