Hospital Resource Use in Ischemic Stroke: Rising Costs and Extended Stays in the U.S. From 2016 to 2022

Understanding trends in hospital length of stay (LOS) and costs for ischemic stroke is essential for improving care delivery and resource allocation. We evaluated national trends from 2016 to 2022, with a focus on the COVID-19 pandemic.

We performed a retrospective analysis using the National Inpatient Sample including adults (≥18 years) with a primary diagnosis of ischemic stroke (ICD-10-CM I63.x). Hospital charges were converted to estimated costs using cost-to-charge ratios and adjusted to 2022 U.S. dollars. Trends were compared between pre-COVID (2016-2019) and COVID-era (2020-2022) periods. Illness severity was stratified by the APR-DRG index, and Pearson correlation assessed the relationship between annual mean LOS and costs.

Among 953 325 ischemic stroke hospitalizations, mean LOS rose from 6.4 days in 2016 to 7.8 days in 2022. Mean hospital costs increased from $19,014 to $28,733 over the same period. COVID-era hospitalizations had significantly higher LOS (7.44 vs 6.47 days; P < 0.001) and costs ($27,006 vs $20,568; P < 0.001) compared to pre-COVID admissions. Annual mean LOS and costs were strongly correlated (r = 0.974, P < 0.001), and greater illness severity was associated with longer LOS and higher costs.

Hospital LOS and costs for ischemic stroke increased markedly from 2016 to 2022, with a sharp rise during the COVID-19 period. While LOS and costs were strongly correlated, additional factors-including illness severity, complication rates, and treatment complexity-likely contribute to rising expenditures. These findings underscore economic burden of stroke care and need for efficient inpatient care models.