The Hematological and Social Factors Affecting Length of Stay in Acute Stroke Patients: A Quality Assessment Study From a Single Institute

Introduction: Stroke is one of the common causes of mortality. The length of stay (LOS) for a stroke is a quality indicator and affects mortality. However, there are no large studies evaluating the LOS in an acute inpatient setting for stroke patients, mainly hematological and social parameters. In this quality assessment observational study, we analyzed the LOS in acute stroke patients at our institute.

Methods: We measured the LOS and divided the study population into two arms, arm A and arm B, to include patients with LOS≤10 and >10 days, respectively. We analyzed various factors affecting LOS and compared the two study arms and the literature.

Results: There were 483 patients with acute stroke in our study. The median LOS was 7.2±6.4 days (range 0.1 to 49.7). Patient age (p<0.00001), female gender (p<0.00001), hemorrhagic stroke (p=0.03), independence with ambulation before stroke (p<0.00001), type of placement (p<0.00001), type of insurance (p=0.0002), obesity (p 0.01) and anemia (p<0.00001), affected the LOS in our study. Most patients in arm B had medical complications (66%) during hospitalization.

Conclusions: In our quality assessment study, we observed that certain factors were associated with longer lengths of stay (LOS) among patients. These included geriatric age, female gender, hemorrhagic stroke, lack of ambulation independence, specific social determinants, discharge disposition to a facility, Medicare/Medicaid insurance, non-obesity, and hematological parameters such as anemia. The majority of these patients had additional medical complications. Thrombocytosis has been linked to reduced mortality in hemorrhagic stroke in the literature. However, our study found that platelet count does not significantly impact the length of stay (LOS) in ischemic stroke patients.