The impact of hospital ownership on ischemic stroke outcomes: A National Inpatient Sample study

Stroke remains a leading cause of morbidity and mortality in the United States, with hospital ownership potentially influencing patient outcomes. This study evaluated how government-owned (GO) versus private for-profit (PFP) hospitals affect the length of stay (LOS), in-hospital mortality, and discharge disposition of stroke patients.

This retrospective cohort study used National Inpatient Sample (NIS) data from 2019 to 2021 to identify patients with ischemic stroke affecting the internal carotid, middle cerebral, vertebral, or basilar arteries. Patients were stratified by hospital ownership type and differences in clinical characteristics and outcomes, including LOS, mortality, and discharge disposition, were analyzed. Multivariable regression models assessed the impact of hospital ownership on outcomes, adjusting for age, race, NIH Stroke Scale (NIHSS), functional status, and socioeconomic factors.

A total of 116,280 stroke patients were included, with 59,755 (51.4 %) treated at GO hospitals and 56,525 (48.6 %) PFP hospitals. Multivariate analysis revealed a protective effect of PFP hospitals on mortality rates (OR 0.70, 95 % CI: 0.65-0.75, p < 0.001), and a shorter LOS (β = -0.33, 95 % CI: -0.47 to -0.19, p < 0.001) when controlling for disease severity via the NIHSS. Further, PFP hospitals had higher odds of discharge to a non-home disposition (OR 1.11, 95 % CI: 1.06-1.16, p < 0.001).

PFP hospitals were associated with shorter LOS and lower mortality rates among stroke patients, but also with a decreased likelihood of discharge to home. After adjusting for disease severity, these disparities persisted. Further research is needed to explore the mechanisms underlying these disparities in patient outcomes based on hospital ownership.