ACUTE STROKE CARE AND REHABILITATION - AN ANALYSIS OF THE DIRECT COSTAND ITS CLINICAL AND SOCIAL DETERMIMANTS - THE COPENHAGEN STROKE STUDY

Background and Purpose Stroke represents a major economic challenge to society. The direct cost of stroke is largely determined by the durat ion of hospital stay, but internationally applicable estimates of the direct cost of acute stroke care and rehabilitation on cost-efficient stroke units are not available. Information regarding social and medic al factors influencing the length of hospital stay (LOHS) and thereby cost is needed to direct cost-reducing efforts. Methods We determined the direct cost of stroke in the prospective, consecutive, and communi ty-based stroke population of the Copenhagen Stroke Study by measuring the total LOHS in the 1197 acute stroke patients included in the stud y. All patients had all their acute care and rehabilitation on a dedic ated stroke unit. Neurological impairment was measured by the Scandina vian Stroke Scale. Local nonmedical factors affecting the LOHS, such a s waiting time for discharge to a nursing home after completed rehabil itation, were accounted for in the analysis. The influence of social a nd medical factors on the LOHS was analyzed in a multiple linear regre ssion model. Results The average LOHS was 27.1 days (SD, 44.1; range, 1 to 193), corresponding to a direct cost of $12.150 per patient inclu ding all acute care and rehabilitation. The LOHS increased with increa sing stroke severity (6 days per 10-point increase in severity; P < .0 001) and single marital status (3.4 days; P = .02). Death reduced LOHS (22.0 days; P < .0001). Age, sex, diabetes, hypertension, claudicatio n, ischemic heart disease, atrial fibrillation, former stroke, other d isabling comorbidity, smoking, daily alcohol consumption, and the type of stroke (hemorrhage/infarct) had no independent influence on LOHS. Conclusions Acute care and rehabilitation of unselected patients on a dedicated stroke unit takes on average 4 weeks. In general, comorbidit y such as diabetes or heart disease does not increase LOHS. Efforts to reduce costs should therefore aim at reducing initial stroke severity or improving the rate of recovery.