Stroke-related Length of Hospitalization Trends and In-hospital Mortality in Peru

Overview

Journal PeerJ

Specialties Biology
Environmental Health
General Medicine

Date 2022 Dec 1

PMID 36452071

Authors

L Max Laban-Seminario

Rodrigo M Carrillo-Larco

Antonio Bernabe-Ortiz

Affiliations

Soon will be listed here.

Abstract

Background: Peru faces challenges to provide adequate care to stroke patients. Length of hospitalization and in-hospital mortality are two well-known indicators of stroke care. We aimed to describe the length of stay (LOS) of stroke in Peru, and to assess in-hospital mortality risk due to stroke, and subtypes.

Methods: This retrospective cohort study used hospitalization registries coding with ICD-10 from 2002 to 2017 ( = 98,605) provided by the Ministry of Health; in-hospital mortality was available for 2016-2017 ( = 6,566). Stroke cases aged ≥35 years were divided into subarachnoid hemorrhage (I60), intracerebral hemorrhage (I61), cerebral infarction (I63), and stroke not specified as hemorrhage or infarction (I64). Data included stroke LOS and in-hospital mortality; socio-demographic and clinical variables. We fitted a region- and hospital level-stratified Weibull proportional hazard model to assess the in-hospital mortality.

Results: The median LOS was 7 days (IQR: 4-13). Hemorrhagic strokes had median LOS longer than ischemic strokes and stroke not specified as hemorrhage or infarction ( = <0.001). The case fatality rate (CFR) of patients with stroke was 11.5% (95% CI [10-12%]). Subarachnoid hemorrhage (HR = 2.45; 95% CI [1.91-3.14]), intracerebral hemorrhage (HR = 1.95; 95% CI [1.55-2.46]), and stroke not specified as hemorrhage or infarction (HR = 1.45; 95% CI [1.16-1.81]) were associated with higher in-hospital mortality risk in comparison to ischemic strokes.

Discussion: Between 2002 and 2017, LOS due to stroke has not changed in Peru in stroke patients discharged alive. Hemorrhagic cases had the longest LOS and highest in-hospital mortality risk during 2016 and 2017. The findings of our study seem to be consistent with a previous study carried out in Peru and similar to that of HIC and LMIC, also there is an increased median LOS in stroke cases managed in specialized centers. Likewise, LOS seems to depend on the type of stroke, where ischemic stroke cases have the lowest LOS. Peru needs to improve access to stroke care.

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References

. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018; 392(10159):1736-1788. PMC: 6227606. DOI: 10.1016/S0140-6736(18)32203-7. View

Otite F, Khandelwal P, Malik A, Chaturvedi S, Sacco R, Romano J . Ten-Year Temporal Trends in Medical Complications After Acute Intracerebral Hemorrhage in the United States. Stroke. 2017; 48(3):596-603. DOI: 10.1161/STROKEAHA.116.015746. View

OBrien E, Wu J, Zhao X, Schulte P, Fonarow G, Hernandez A . Healthcare Resource Availability, Quality of Care, and Acute Ischemic Stroke Outcomes. J Am Heart Assoc. 2017; 6(2). PMC: 5523738. DOI: 10.1161/JAHA.116.003813. View

Qureshi A, Mendelow A, Hanley D . Intracerebral haemorrhage. Lancet. 2009; 373(9675):1632-44. PMC: 3138486. DOI: 10.1016/S0140-6736(09)60371-8. View

Stienen M, Germans M, Burkhardt J, Neidert M, Fung C, Bervini D . Predictors of In-Hospital Death After Aneurysmal Subarachnoid Hemorrhage: Analysis of a Nationwide Database (Swiss SOS [Swiss Study on Aneurysmal Subarachnoid Hemorrhage]). Stroke. 2018; 49(2):333-340. DOI: 10.1161/STROKEAHA.117.019328. View

Audebert H, Sobesky J . Stroke: 'time is brain' after stroke, regardless of age and severity. Nat Rev Neurol. 2014; 10(12):675-6. DOI: 10.1038/nrneurol.2014.194. View

Tamm A, Siddiqui M, Shuaib A, Butcher K, Jassal R, Muratoglu M . Impact of stroke care unit on patient outcomes in a community hospital. Stroke. 2013; 45(1):211-6. DOI: 10.1161/STROKEAHA.113.002504. View

Alvarado-Dulanto C, Lazo M, Loza-Herrera J, Malaga G . [One year prognosis after suffering the onset of cerebrovascular disease in patients from a public hospital in Lima, Peru]. Rev Peru Med Exp Salud Publica. 2015; 32(1):98-103. View

Castaneda-Guarderas A, Beltran-Ale G, Casma-Bustamante R, Ruiz-Grosso P, Malaga G . [Registry of patients with stroke stated in a public hospital of Peru, 2000-2009]. Rev Peru Med Exp Salud Publica. 2012; 28(4):623-7. DOI: 10.1590/s1726-46342011000400008. View

10.

Sposato L, Esnaola M, Zamora R, Zurru M, Fustinoni O, Saposnik G . Quality of ischemic stroke care in emerging countries: the Argentinian National Stroke Registry (ReNACer). Stroke. 2008; 39(11):3036-41. DOI: 10.1161/STROKEAHA.108.521062. View

11.

Langhorne P, Audebert H, Cadilhac D, Kim J, Lindsay P . Stroke systems of care in high-income countries: what is optimal?. Lancet. 2020; 396(10260):1433-1442. DOI: 10.1016/S0140-6736(20)31363-5. View

12.

Feigin V, Forouzanfar M, Krishnamurthi R, Mensah G, Connor M, Bennett D . Global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet. 2014; 383(9913):245-54. PMC: 4181600. DOI: 10.1016/s0140-6736(13)61953-4. View

13.

Zachrison K, Onnela J, Reeves M, Hernandez A, Camargo Jr C, Zhao X . Hospital Factors Associated With Interhospital Transfer Destination for Stroke in the Northeast United States. J Am Heart Assoc. 2020; 9(1):e011575. PMC: 6988147. DOI: 10.1161/JAHA.118.011575. View

14.

Bray B, Paley L, Hoffman A, James M, Gompertz P, Wolfe C . Socioeconomic disparities in first stroke incidence, quality of care, and survival: a nationwide registry-based cohort study of 44 million adults in England. Lancet Public Health. 2018; 3(4):e185-e193. PMC: 5887080. DOI: 10.1016/S2468-2667(18)30030-6. View

15.

Feigin V, Lawes C, Bennett D, Barker-Collo S, Parag V . Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol. 2009; 8(4):355-69. DOI: 10.1016/S1474-4422(09)70025-0. View

16.

Andersen K, Olsen T, Dehlendorff C, Kammersgaard L . Hemorrhagic and ischemic strokes compared: stroke severity, mortality, and risk factors. Stroke. 2009; 40(6):2068-72. DOI: 10.1161/STROKEAHA.108.540112. View

17.

Deljavan R, Farhoudi M, Sadeghi-Bazargani H . Stroke in-hospital survival and its predictors: the first results from Tabriz Stroke Registry of Iran. Int J Gen Med. 2018; 11:233-240. PMC: 6016014. DOI: 10.2147/IJGM.S158296. View

18.

Emberson J, Lees K, Lyden P, Blackwell L, Albers G, Bluhmki E . Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet. 2014; 384(9958):1929-35. PMC: 4441266. DOI: 10.1016/S0140-6736(14)60584-5. View

19.

Reed S, Blough D, Meyer K, Jarvik J . Inpatient costs, length of stay, and mortality for cerebrovascular events in community hospitals. Neurology. 2001; 57(2):305-14. DOI: 10.1212/wnl.57.2.305. View

20.

Saltman A, Silver F, Fang J, Stamplecoski M, Kapral M . Care and Outcomes of Patients With In-Hospital Stroke. JAMA Neurol. 2015; 72(7):749-55. DOI: 10.1001/jamaneurol.2015.0284. View