Predictors of acute hospital costs for treatment of ischemic stroke in an academic center

Background and Purpose-We sought to determine predictors of acute hospital costs in patients presenting with acute ischemic stroke to an academic cent er using a stroke management team to coordinate care. Methods-Demographic and clinical data were prospectively collected on 191 p atients consecutively admitted with acute ischemic stroke. Patients were cl assified by insurance status, premorbid modified Rankin scale, stroke locat ion, stroke severity (National Institutes of Health Stroke Scale score), an d presence of comorbidities. Detailed hospital charge data were converted t o cost by application of department-specific cost-to-charge ratios. Physici an's fees were not included. A stepwise multiple regression analysis was co mputed to determine the predictors of total hospital cost. Results-Median length of stay was 6 days (range, 1 to 63 days), and mortali ty was 3%. Median hospital cost per discharge was $4408 (range, $1199 to $5 9 799). Fifty percent of costs were for room charges, 19% for stroke evalua tion, 21% for medical management, and 7% for acute rehabilitation therapies . Sixteen percent were admitted to an intensive care unit. Length of stay a ccounted for 33% of the variance in total cost. Other independent predictor s of cost included stroke severity, heparin treatment, atrial fibrillation, male sex, ischemic cardiac disease, and premorbid functional status. Conclusions-We conclude that the major predictors of acute hospital costs o f stroke in this environment are length of stay, stroke severity, cardiac d isease, male sex, and use of heparin. Room charges accounted for the majori ty of costs, and attempts to reduce the cost of stroke evaluation would be of marginal value. Efforts to reduce acute costs should be monitored for po tential cost shifting or a negative impact on quality of care.