Using the National Inpatient Sample (NIS) database, we will examine national trends, demographic characteristics, and in-hospital outcomes among patients hospitalized with small-vessel stroke in the United States from 2016 to 2021. 

Small-vessel stroke, a common kind of ischemic stroke, accounts for a significant portion of cerebrovascular morbidity and disability.  Despite its relatively good prognosis as compared to large-vessel blockage, national trends and hospital outcomes for individuals with small-vessel stroke remain poorly characterized. 

This retrospective cross-sectional research is based on data from the NIS database (2016-2021).  Adults aged 18 and above with a significant diagnosis of small-vessel stroke were identified using ICD-10 codes I63.81 and I63.9.  Weighted analysis yielded national estimates.  The primary outcomes were in-hospital mortality, discharge disposition, and duration of stay.  Secondary outcomes included temporal patterns, comorbidities, and hospital-level characteristics.  

A total of roughly 210,000 weighted hospitalizations for small-vessel stroke were reported.  The average age was 68.4 years, and 53 percent were men.  The total in-hospital mortality rate was 1.7%, which remained consistent throughout the study period (p = 0.12).  Discharges to homes fell significantly, from 68 percent in 2016 to 64 percent in 2021, while discharges to skilled care institutions increased.  Elderly people, non-Hispanic Black patients, and those admitted to remote hospitals had higher death rates.  Predictors of death were age ≥80 years (aOR 2.1), congestive heart failure (aOR 1.8), and renal failure (aOR 1.5).  The length of stay decreased somewhat, from 4.6 to 4.3 days. 

Small-vessel stroke outcomes have remained virtually consistent nationally, although variances exist within demographic and institutional groupings.  Older people, ethnic groups, and patients in rural areas continue to have worse results.  These results highlight the importance of equitable post-stroke treatment pathways, targeted resource allocation, and early rehabilitation in improving recovery and reducing national disparities.