What is the average length of hospital stay for a patient with post-stroke (cerebrovascular accident) complications?

From the Guidelines

The median length of stay in the hospital after a stroke is six days, with an inter-quartile range of 3 to 15 days, according to the most recent evidence 1. The duration of hospitalization after a stroke can vary significantly depending on the severity of the stroke and the presence of complications.

Factors Influencing Hospital Stay

• Severity of the stroke
• Presence of complications such as dysphagia, pneumonia, urinary tract infections, deep vein thrombosis, seizures, and brain swelling
• Need for stabilization, diagnostic testing, and initiation of secondary stroke prevention
• Availability of support systems for discharge

Hospitalization Period

The hospitalization period is crucial for the management of stroke sequelae, prevention of post-stroke complications, and prevention of stroke recurrence.

• Stabilization and diagnostic testing are prioritized to assess the patient's condition and determine the best course of treatment.
• Initiation of secondary stroke prevention, such as antiplatelet therapy, is also a key component of the hospitalization period.
• Early rehabilitation is essential for optimal recovery and typically starts within 24-48 hours after the stroke if the patient is medically stable.

Discharge Planning

The medical team continuously assesses the patient's progress to determine when discharge to home, inpatient rehabilitation, or a skilled nursing facility is appropriate based on functional status and available support systems.

• The goal is to ensure a safe and supportive environment for the patient's continued recovery and rehabilitation.
• The decision to discharge is made on a case-by-case basis, taking into account the individual patient's needs and circumstances. According to the Canadian Stroke Best Practice Recommendations 1, the priorities for inpatient care are management of stroke sequelae to optimize recovery, prevention of post-stroke complications, and prevention of stroke recurrence. While other studies, such as the one published in Circulation 1, provide information on the risk of cardiac-related events after stroke, the primary focus of the question is on the length of hospital stay after a stroke, which is best addressed by the Canadian Stroke Best Practice Recommendations 1.

From the Research

Hospitalization Duration After Stroke

• The duration of hospitalization after a stroke can vary depending on several factors, including the severity of the stroke, the presence of complications, and the patient's overall health status 2.
• A study published in the journal Stroke found that approximately 75% of patients admitted with transient ischemic attack stay in the hospital for ≥ 2 days, with the most important determinants being pre-existing medical comorbidities 2.
• The same study found that the mean hospitalization charges were $10,876, $17,187, and $38,200 for patients hospitalized for ≤ 1,2 to 6, and ≥ 7 days, respectively 2.
• Another study published in the journal Medicine found that patients experiencing acute ischemic stroke or transient ischemic attack are commonly treated with clopidogrel and/or aspirin to minimize the risk for recurrent stroke, but the duration of hospitalization was not specifically reported 3.
• A cost-effectiveness analysis published in the American Journal of Cardiology found that clopidogrel plus aspirin was cost-effective compared to aspirin alone for stroke prevention in patients with atrial fibrillation, but the duration of hospitalization was not a primary outcome measure 4.

Factors Associated with Length of Hospitalization

• Age >65 years, female sex, admission to teaching hospitals, renal failure, hypertension, diabetes mellitus, chronic lung disease, congestive heart failure, atrial fibrillation, ischemic stroke occurrence, Medicare/Medicaid insurance, and hospital location in the Northeast US region were associated with a length of hospitalization of ≥ 2 days 2.
• The use of thrombolytics was very low among patients hospitalized for ≤ 1,2 to 6, and ≥ 7 days, with rates of 0.03%, 0.09%, and 0.1%, respectively 2.

Complications of Stroke

• Complications of stroke, such as recurrent stroke, myocardial infarction, and bleeding events, can affect the duration of hospitalization and the patient's overall outcome 5, 6, 3.
• The risk of major bleeding was higher with dual antiplatelet therapy (clopidogrel plus aspirin) compared to monotherapy (aspirin alone) 3.