title: Trends in Outcome and Hospitalization Cost among Adult Patients with Acute Ischemic Stroke in the United States.
abstract: BACKGROUND
  New treatments for acute ischemic stroke (AIS) have been introduced and are expected to improve patients' overall outcomes. We assessed the impact of new therapeutic strategies on outcome and cost of hospitalization among adult patients with AIS in the United States.
  
  
  METHODS
  Patients with AIS admitted in the United States in 1993-1994 and 2006-2007 were listed using the Nationwide Inpatient Survey database. We determined the rates of occurrence, hospitalization outcomes, and mean hospital charges for all patients. We further analyzed these variables in the ventilated and nonventilated patients.
  
  
  RESULTS
  We identified 386,043 patients with AIS admitted in the United States in 1993-1994 and 749,766 patients in 2006-2007. The length of hospitalization was significantly higher in 1993-1994 compared with 2006-2007: 6.9 ± 4.2 days versus 4.66 ± 3 days, respectively. In-hospital mortality rate was 8.9% in 1993-1994 and 5.6% in 2006-2007 (P < 0.0001). There was a significant increase in mean hospital charges in 2006-2007 compared with 1993-1994 ($21,916 ± $14,117 versus $9,646 ± $5,727). The length of hospitalization was significantly shorter in 2006-2007 in nonventilated patients. There was a significant increase in mean hospital charges in 2006-2007 compared with 1993-1994 in both ventilated ($81,528 ± $64,526 versus $25,143 ± $17,172, P<0.0001) and nonventilated patients ($21,085 ± $13,042 versus $10,000 ± $6,300, P<0.0001). The mortality rate was significantly lower in 2006-2007 in both subgroups: 46.5% versus 59.8% in ventilated patients and 4.2% versus 8.2% in nonventilated patients (P < 0.0001).
  
  
  CONCLUSIONS
  Our study suggests that new therapeutic strategies have improved outcomes and increased cost of hospitalization among adult patients with AIS in the United States over a period of 13 years. The hospitalization cost was significantly higher in the ventilated and nonventilated patients in 2006-2007, which may reflect the impact of new therapeutic strategies, the availability of more intensive care units and stroke centers, and the lower mortality rate in this time period.
authors.affiliation: Center for Advanced Health Care, Lehigh Valley Health Network, Allentown, PA, USA.
authors.forename: Hussam A
authors.initials: HA
authors.lastname: Yacoub
authors.affiliation: Department of Clinical Neurophysiology, Neuromuscular Track, The Neurological Institute of New York, Columbia University, New York, NY, USA.
authors.forename: Zaid A
authors.initials: ZA
authors.lastname: Al-Qudah
authors.affiliation: Department of Epidemiology & Biostatistics, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA.
authors.forename: Hafiz M R
authors.initials: HM
authors.lastname: Khan
authors.affiliation: Coastal Neurology Services Inc., Dover, NH, USA.
authors.forename: Khosro
authors.initials: K
authors.lastname: Farhad
authors.affiliation: Washington University in St. Louis, St. Louis, MO, USA.
authors.forename: Andrew Bo-Hua
authors.initials: AB
authors.lastname: Ji
authors.affiliation: Neurological Institute of New Jersey, Rutgers, The State University of New Jersey, Newark, NJ, USA.
authors.forename: Nizar
authors.initials: N
authors.lastname: Souayah
keywords: acute ischemic stroke; cost; length of stay; mortality; outcome