Clinical Predictors of Prolonged Hospital Stay after Acute Stroke: Relevance of Medical Complications


Purpose: This study aims to identify clinical predictors of prolonged hospital stay after acute stroke based on data collected from a prospective hospital-based acute stroke registry. Methods: All patients with first-ever ischemic stroke and primary intracerebral hemorrhage included in the Sagrat Cor Hospital of Barcelona stroke database over a 17-year period were assessed. Prolonged hospital stay was defined as hospitalization for longer than 12 days after admission. Demographic data, cardiovascular risk factors, clinical factors, neuroimaging findings, and outcome were compared in patients hospitalized for more or less than 12 days. Logistic regression analysis was used to assess the independent influence of statistically significant variables in the bivariate analysis and duration of hospitalization. Results: Of a total of 3112 acute stroke patients included in the study, prolonged hospital stay was recorded in 1536 (49.4%). Male sex (OR = 1.16), limb weakness (OR = 1.79), vascular complications (OR = 2.68), urinary complications (OR = 2.56), and infectious complications (OR = 1.78) were independently associated with longer stay, whereas symptom free at discharge (OR = 0.45) and lacunar infarction (OR = 0.43) were inversely associated with prolonged hospitalization. Conclusion: In-hospital medical complications (vascular, urinary, and infectious) are relevant factors influencing duration of hospitalization after acute stroke. Therefore, prevention of potentially modifiable risk factors for medical complications is an important aspect of the early management of patients with stroke.

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A. Arboix, J. Massons, L. García-Eroles, C. Targa, M. Oliveres and E. Comes, "Clinical Predictors of Prolonged Hospital Stay after Acute Stroke: Relevance of Medical Complications," International Journal of Clinical Medicine, Vol. 3 No. 6, 2012, pp. 502-507. doi: 10.4236/ijcm.2012.36090.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] G. Saposnik, F. Webster, C. O’Callaghan and V. Hachinski, “Optimizing Discharge Planning: Clinical Predictors of Longer Stay after Recombinant Tissue Plasminogen Activator for Acute Stroke,” Stroke, Vol. 36, No. 1, 2004, pp. 147-150. doi:10.1161/01.STR.0000150492.12838.66
[2] A. van Straten, J. H. P. van der Meulen, G. A. M. van den Bos and M. Limburg, “Length of Hospital Stay and Discharge Delays in Stroke Patients,” Stroke, Vol. 28, No. 1, 1997, pp. 137-140. doi:10.1161/01.STR.28.1.137
[3] P. U. Heuschmann, P. L. Kolominsky-Rabas, B. Misselwitz, P. Hermanek, C. Leffmann, G. M. Von Reutern, L. Lachenmayer, H. J. Bucker-Nott and K. Berger, “Factors Influencing Duration of Hospitalization after Stroke in Germany,” Deutsche Medizinische Wochenschrift, Vol. 129, No. 7, 2004, pp. 299-304. doi:10.1055/s-2004-818624
[4] N. Spratt, Y. Wang, C. Levi, K. Ng, M. Evans and J. Fisher, “A Prospective Study of Predictors of Prolonged Hospital Stay and Disability after Stroke,” Journal of Clinical Neuroscience, Vol. 10, No. 6, 2003, pp. 665-669. doi:10.1016/j.jocn.2002.12.001
[5] R. Hara-Watanabe, Y. Inatomi, T. Yonehara, S. Fujioka, Y. Hashimoto, T. Hirano and M. Uchino, “Prolonged Factors of Length of Hospital Stay in Acute Ischemic Stroke,” Rinsho Shinkeigaku, Vol. 45, No. 6, 2005, pp. 405-410.
[6] H. C. Lee, K. C. Chang, C. F. Lan, C. T. Hong, Y. C. Huang and M. L. Chang, “Factors Associated with Prolonged Hospital Stay for Acute Stroke in Taiwan,” Acta Neurologica Taiwanica, Vol. 17, No. 1, 2008, pp. 17-25.
[7] Early Supported Discharge Trialists, “Services for Reducing Duration of Hospital Care for Acute Stroke Patients,” Cochrane Database of Systematic Reviews, Vol. 18, No. 2, 2005, Article ID: CD000443.
[8] A. Arboix, C. Morcillo, L. García-Eroles, M. Oliveres, J. Massons and C. Targa, “Different Vascular Risk Factor Profiles in Ischemic Stroke Subtypes: A Study from the ‘Sagrat Cor Hospital of Barcelona Stroke Registry’,” Acta Neurologica Scandinavica, Vol. 102, No. 4, 2000, pp. 264-270. doi:10.1034/j.16000404.2000.102004264.x
[9] A. Arboix, J. Alvarez-Sabín, L. Soler, “Nomenclatura de las Enfermedades Vasculares Cerebrales,” Neurologia, Vol. 13, Suppl. 1, 1998, pp. 1-10.
[10] Special Report from the National Institute of Neurological Disorders and Stroke, “Classification of Cerebrovascular Diseases. III,” Stroke, Vol. 21, No. 4, 1990, pp. 637- 676. doi:10.1161/01.STR.21.4.637
[11] A. Arboix, L. García-Eroles, J. Massons, M. Oliveres and C. Targa, “Hemorrhagic Lacunar Stroke,” Cerebrovascular Diseases, Vol. 10, No. 3, 2000, pp. 229-234. doi:10.1159/000016061
[12] A. Arboix, V. Cendrós, M. Besa, L. García-Eroles, M. Oliveres, C. Targa, M. Balcells, E. Comes and J. Massons, “Trends in Risk Factors, Stroke Subtypes and Outcome. Nineteen-Year Data from the Sagrat Cor Hospital of Barcelona Stroke Registry,” Cerebrovascular Diseases, Vol. 26, No. 5, 2008, pp. 509-516. doi:10.1159/000155989
[13] F. L. Silver, J. W. Norris, A. J. Lewis and V. C. Hachinski, “Early Mortality Following Stroke: A Prospective Review,” Stroke, Vol. 15, No. 3, 1984, pp. 492-496. doi:10.1161/01.STR.15.3.492
[14] J. V. Tu and Y. Gong, “Trends in Treatment and Outcomes for Acute Stroke Patients in Ontario, 1992-1998,” Archives of Internal Medicine, Vol. 163, No. 3, 2003, pp. 293-297. doi:10.1001/archinte.163.3.293
[15] K. C. Chang, M. C. Tseng, H. H. Weng, Y. H. Lin, C. W. Liou and T. Y. Tan, “Prediction of Length of Stay of First-Ever Ischemic Stroke,” Stroke, Vol. 33, No. 11, 2002, pp. 2670-2674. doi:10.1161/01.STR.0000034396.68980.39
[16] W. F. Westendop, P. J. Nederkoom, J. D. Vermeij, M. G. Dijkgraaf and D. van de Beek, “Post-Stroke Infection: A Systematic Review and Meta-Analysis,” BMC Neurology, Vol. 11, 2011, p. 110. doi:10.1186/1471-2377-11-110
[17] F. H. Vermeij, W. J. Scholte op Reimer, P. De Man, R. J. Oostenbrugge, C. L. Franke, G. De Jong, P. L. de Kort and D. W. Dippel, “Stroke-Associated Infection Is an Independent Risk Factor for Poor Outcome after Acute Ischemic Stroke: Data from the Netherlands Stroke Survey,” Cerebrosacular Diseases, Vol. 27, No. 5, 2009, pp. 465-471.
[18] E. Díez-Tejedor and B. Fuentes, “Acute Care in Stroke: Do Stroke Units Make the Difference?” Cerebrovascular Diseases, Vol. 11, Suppl. 1, 2001, pp. 31-39. doi:10.1159/000049123
[19] P. Appelros, “Prediction of Length of Stay for Stroke Patients,” Acta Neurological Scandinavica, Vol. 116, No. 1, 2007, pp. 15-19. doi:10.1111/j.1600-0404.2006.00756.x
[20] A. Arboix, I. Padilla, L. García-Eroles, J. Massons, E. Comes and C. Targa, “Pure Motor Hemiparesis: A Clinical Study of 222 Patients,” Journal of Neurology Neuro- surgery and Psychiatry, Vol. 71, No. 2, 2001, pp. 239-242. doi:10.1136/jnnp.71.2.239
[21] A. Arboix, M. Oliveres, L. García-Eroles, C. Maragall, J. Massons and C. Targa, “Acute Cerebrovascular Disease in Women,” European Neurology, Vol. 45, No. 4, 2001, pp. 199-205. doi:10.1159/000052130
[22] A. Forster, A. Gass, R. Kern, M. E. Wolf, C. Ottomeyer, K. Zohsel, M. Hennerici and K. Szabo, “Gender Differences in Acute Ischemic Stroke. Etiology, Stroke Patterns and Response to Thrombolysis,” Stroke, Vol. 40, No. 7, 2009, pp. 2428-2432. doi:10.1161/STROKEAHA.109.548750

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