Jørgensen H S, Nakayama H, Raaschou H O, Olsen T S
Department of Neurology, Bispehjerg Hospital, Copenhagen, Denmark.
Stroke. 1997 Jun;28(6):1138-41. doi: 10.1161/01.str.28.6.1138.
Stroke represents a major economic challenge to society. The direct cost of stroke is largely determined by the duration 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 medical factors influencing the length of hospital stay (LOHS) and thereby cost is needed to direct cost-reducing efforts.
We determined the direct cost of stroke in the prospective, consecutive, and community-based stroke population of the Copenhagen Stroke Study by measuring the total LOHS in the 1197 acute stroke patients included in the study. All patients had all their acute care and rehabilitation on a dedicated stroke unit. Neurological impairment was measured by the Scandinavian Stroke Scale. Local nonmedical factors affecting the LOHS, such as waiting time for discharge to a nursing home after completed rehabilitation, were accounted for in the analysis. The influence of social and medical factors on the LOHS was analyzed in a multiple linear regression model.
The average LOHS was 27.1 days (SD, 44.1; range, 1 to 193), corresponding to a direct cost of $12.150 per patient including all acute care and rehabilitation. The LOHS increased with increasing stroke severity (6 days per 10-point increase in severity; P < .0001) and single marital status (3.4 days; P = .02). Death reduced LOHS (22.0 days; P < .0001). Age, sex, diabetes, hypertension, claudication, ischemic heart disease, atrial fibrillation, former stroke, other disabling comorbidity, smoking, daily alcohol consumption, and the type of stroke (hemorrhage/infarct) had no independent influence on LOHS.
Acute care and rehabilitation of unselected patients on a dedicated stroke unit takes on average 4 weeks. In general, comorbidity 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.
中风给社会带来了重大的经济挑战。中风的直接成本很大程度上取决于住院时间，但目前尚无适用于国际的关于急性中风护理和在具有成本效益的中风单元进行康复的直接成本的估计。需要有关影响住院时间（LOHS）进而影响成本的社会和医学因素的信息，以指导降低成本的努力。
我们通过测量哥本哈根中风研究中纳入的1197例急性中风患者的总住院时间，确定了该前瞻性、连续性和基于社区的中风人群中中风的直接成本。所有患者均在专门的中风单元接受所有急性护理和康复治疗。通过斯堪的纳维亚中风量表测量神经功能缺损。分析中考虑了影响住院时间的当地非医学因素，如康复完成后等待转至疗养院的时间。在多元线性回归模型中分析社会和医学因素对住院时间的影响。
平均住院时间为27.1天（标准差，44.1；范围，1至193天），相当于每位患者包括所有急性护理和康复的直接成本为12,150美元。住院时间随着中风严重程度的增加而增加（严重程度每增加10分，住院时间增加6天；P <.0001）和单身婚姻状况（增加3.4天；P =.02）。死亡缩短了住院时间（缩短22.0天；P <.0001）。年龄、性别、糖尿病、高血压、跛行、缺血性心脏病、心房颤动、既往中风、其他致残性合并症、吸烟、每日饮酒量以及中风类型（出血/梗死）对住院时间均无独立影响。
在专门的中风单元对未选择的患者进行急性护理和康复平均需要4周时间。一般来说，糖尿病或心脏病等合并症不会增加住院时间。因此，降低成本的努力应旨在降低初始中风严重程度或提高恢复率。
