Abstract WP086: Length of Stay, Insurance Payer&Cost Trends in Stroke Admissions in the United States Before&During the COVID-19 Pandemic

Importance: The COVID-19 pandemic disrupted stroke care across the U.S. Assessing trends in hospital length of stay (LOS), insurance payer status, hospitalization costs per admission for acute ischemic stroke (AIS)&outcomes is crucial for future emergency preparedness and for building resilient healthcare systems. Objective: To evaluate the impact of the COVID-19 pandemic on LOS, insurance payer type&direct inpatient hospitalization costs for AIS admissions across the United States from 2016 to 2021. Methods: We performed a retrospective cohort study using the National Inpatient Sample (NIS) from 2016 to 2021, analyzing adult AIS admissions (N=3,165,154). Costs were estimated by multiplying total NIS charges by the annual cost-to-charge ratio&adjusting for inflation using the 2021 Consumer Price Index. Trends in continuous variables (LOS&adjusted costs) were assessed annually using the `SURVEYREG` procedure, accounting for stratification, clustering&survey weighting to produce nationally representative trends. LOS&costs were compared between the pre-pandemic period (2016–2019)&the peri-pandemic period (2020–2021). Payer distribution was also compared between pre-&peri-COVID-19 periods. Statistical significance was set at P < 0.05. Results: Annual trends indicated a steady increase in both LOS&hospitalization costs for AIS from 2016 to 2021 (Table 1). Medicare remained the primary payer, covering 64.6% of cases overall. Medicare covered 30.9% of patients from the lowest income quartile. However, Medicare's share declined slightly during the pandemic, while Medicaid&private insurance coverage increased. LOS increased from 5.0 ± 0.02 to 5.3 ± 0.04 days&inflation-adjusted mean hospitalization costs rose from $16,094 ± 76.30 to $18,419 ± 139.30 when comparing pre-COVID to peri-COVID periods (Table 2). Conclusions: Between 2016&2021, AIS hospitalizations in the U.S. were characterized by rising LOS&increasing inflation-adjusted costs, trends that persisted through the COVID-19 pandemic. Changes in insurance payer distribution, notably the decline in Medicare coverage&the increase in Medicaid&private insurance, may reflect shifts in patient demographics&access to care. Public payers should anticipate increased cost burdens in pandemic settings. These findings underscore the growing economic burden of stroke care, emphasizing the need for healthcare systems to adapt financing&resources to withstand future public health challenges.