Impact of Schizophrenia on Inpatient Outcomes for Acute Ischemic Stroke: Evidence From the 2005–2020 United States Nationwide Inpatient Sample

BACKGROUND AND PURPOSE: This study investigated the impact of schizophrenia on the outcomes of hospitalizations for acute ischemic stroke (AIS). Previous studies have suggested that outcomes are worse for patients with both AIS and schizophrenia, but a definitive conclusion is lacking. METHODS: A retrospective analysis of the 2005-2020 United States Nationwide Inpatient Sample was conducted. Patients aged ≥20 years who were hospitalized for AIS were divided into two groups: with and without schizophrenia. The groups were matched using propensity-score matching at a 1:4 ratio. The assessed outcomes included in-hospital mortality, unfavorable discharge, length of hospital stay (LOS), and major complications. Logistic and linear regression analyses were used to assess outcome relationships. RESULTS: Matching resulted in 43,545 patients being analyzed: 8,709 with schizophrenia and 34,836 without schizophrenia. Schizophrenia was associated with higher risks of mortality (odds ratio [OR]=1.16), unfavorable discharge (OR=2.00), prolonged LOS (OR=1.61), and major complications (OR=1.39) including acute myocardial infarction, venous thromboembolism, pneumonia, sepsis, and acute kidney injury. Schizophrenia was also associated with higher total hospital costs (beta=6.73). The associations were consistent across most subgroups. CONCLUSIONS: Schizophrenia significantly worsens the outcomes in AIS patients, contributing to higher mortality, prolonged LOS, more complications, and increased hospital costs. These findings highlight the need to apply tailored management strategies to AIS patients with schizophrenia.