Introduction. Prolonged length of stay (pLOS) following ischemic stroke inflates cost, increases risk for hospital-acquired complications, and has been associated with worse prognosis. Methods. Acute ischemic stroke patients admitted between July 2008 and December 2010 were retrospectively analyzed for pLOS, defined as a patient stable for discharge hospitalized for an additional ≥24 hours. Results. Of 274 patients included, 106 (38.7%) had pLOS (median age 65 years, 60.6% female, 69.0% black). Patients with pLOS had higher admission NIHSS than patients without pLOS (9 versus 5, ). A larger proportion of patients with pLOS developed an infection ( ), and after adjusting for covariates, these patients had greater odds of poor short-term functional outcome (OR = 2.25, 95% CI 1.17–4.32, ). Adjusting for infection, the odds of patients with pLOS having poor short-term functional outcome were no longer significant (OR = 1.68, 95% CI 0.83–3.35, ). Conclusions. The contraction of a hospital-acquired infection was a significant predictor of pLOS and a contributor of poor short-term outcome following an ischemic stroke. Whether the cause or the consequence of pLOS, hospital-acquired infections are largely preventable and a target for reducing length of stay. 1. Introduction Typical management of acute stroke has a variable duration, lasting from 5 to 14 days on average [1, 2]. Longer stays are more common in older patients [2–4] and those with more severe strokes [1], anterior circulation infarcts [2, 4], atrial fibrillation [1, 4], and hemorrhagic-type strokes [1, 2]. Longer stays also correlate with worse functional outcome and unfavorable discharge disposition in patients with acute ischemic stroke (AIS) [4, 5]. Koton et al. demonstrated a valid scoring tool to identify patients with stroke at risk for a hospitalization of ≥7 days at triage [1, 6]. Unfortunately, this tool was designed to predict prolonged hospitalization using common data elements collected at triage, failing to take into account complications that may occur during the inpatient stay. Second, studies that have described in-hospital associations with pLOS defined length of stay by an absolute threshold, with some using a threshold of about 30 days [4, 7]. These studies do not compare differences between patients with and without pLOS. More importantly, they do not include patients with pLOS with a hospital course of <30 days—which represents the majority of stroke patients at U.S. centers [8]. In this study, we define pLOS without a threshold to better demonstrate its associations. We aim to
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