Outcomes of ischemic stroke in safety-net hospitals

Safety-net hospitals (SNHs) often face financial limitations and resource shortages compared to their counterparts. We hypothesized that patients with ischemic stroke treated at SNHs would have inferior outcomes compared to non-SNHs.

This retrospective study used the National Inpatient Sample Database to study patients who were ≥18 years old and hospitalized for acute ischemic stroke from 2016 to 2019. The characteristics and outcomes of the patients with or without safety-net features treated at SNHs vs non-SNHs were compared. A composite adverse outcome was also generated to include in-hospital mortality, acute respiratory failure, tracheostomy, and sepsis.

We identified a weighted total of 1,823,985 patients, including 448,965 treated at SNHs and 1,375,020 at non-SNHs. The patients treated at SNHs were associated with higher in-hospital mortality (adjusted odds ratio [aOR] 1.14, 95% confidence interval [CI] 1.09-1.19) and composite adverse outcome (aOR 1.18, 95% CI 1.14-1.21), and longer hospital length of stay (5.6±7.7 vs 4.5±5.4 days, p<0.001). Patients without safety-net features who were cared for at SNHs had higher in-hospital mortality (aOR 1.14, 95% CI 1.09-1.19), and composite adverse outcomes (aOR 1.19, 95% CI 1.15-1.23) compared to those treated at non-SNHs.

Patients treated for ischemic stroke at SNHs have higher in-hospital mortality and an increased risk for adverse outcomes. Such a pattern was observed for patients without safety-net features but not patients with safety-net features. These findings support changes in resource allocation and efforts to improve the care of ischemic stroke in SNHs.