Abstract 12717: Changing Frequencies, Outcomes and Costs for Ischemic Strokes (ISs), Subarachnoid Hemorrhages (SAHs) and Other Hemorrhagic Strokes (OHSs), 2006-2013
Background: While ISs, SAHs and OHSs differ in many key aspects, their results are combined in some reported statistics.
Methods: For ICD-9-CM principal discharge (D/C) diagnosis codes of 430 (SAH), 431-432 (OHS) and 433-434 (IS), we estimated US nationwide adult stroke frequencies and outcomes using data from the Healthcare Cost and Utilization Project (HCUP). HCUP’s sampling frame captured ~90% of D/Cs from non-Federal acute care hospitals for 2006, and 95+% of such D/Cs by 2013. Data based on HCUP’s Nationwide/al Inpatient Sample (a stratified sample of 20% of HCUP hospital D/Cs) came from the HCUPnet on-line query system.
Results: There were 653,429 adult stroke D/Cs (290.1/100,000) in 2006. Among ISs (82.0% of all cases), 4.4% died as inpatients, 49.3% were routine D/Cs and the rest (46.3%) went to other care settings. Mean length of stay (MLOS) was 4.8 days. Mean hospital costs (not charges) in 2015 US $ were $11,639/case. Among SAHs (4.1%), inpatient mortality was 23.1% and 35.2% were routine D/Cs. MLOS was 12.3 days. Mean costs were $48,533. Among OHSs (13.9%), 24.3% died as inpatients and 24.3% were routine D/Cs. MLOS was 7.8 days. Mean costs were $20,206. There were 684,620 adult cases (281.9/100,000) in 2013. Among ISs (82.3%), 3.7% died as inpatients; 44.9% were routine D/Cs. MLOS was 4.4 days. Mean costs were $12,101. Among SAHs (3.6 %), mortality was 19.6%; 38.0% were routine D/Cs. MLOS was 11.8 days. Mean costs were $53,202. Among OHSs (14.0%), mortality was 20.3%; 23.7% were routine D/Cs. MLOS was 7.1 days. Mean costs were $19,862. Each year in all stroke types, 85+ year olds had the highest incidence and mortality, especially compared to 18-44 YOs. Rankings by mean LOS and mean costs/case varied by age across stroke types.
Discussion: Overall and age-specific incidence rates by stroke type changed slightly over time. Adult inpatient mortality and LOS fell for all types. Mean inflation-adjusted costs generally rose, implying increasing mean costs/day. Total aggregate costs (which do not include most rehabilitation costs) rose from $9.4 to 10.0 billion/year. ISs accounted for most cases. However, lower incidence rates, worse outcomes and higher resource use seen in OHSs and especially SAHs relative to ISs argue for separate tracking of stroke type results.
Author Disclosures: D.T. Gray: None. A.M. McLeod: None.
- © 2016 by American Heart Association, Inc.