Mina A Allo
Background: Multiple large trials have demonstrated efficacy of mechanical thrombectomy for acute ischemic stroke (IS) since 2014; clinical practice has changed accordingly. We analyzed the period between 2014-2016 for temporal trends in outcomes during this transition. Methods: The National Inpatient Sample, a 20% sample of all US hospital discharges, was analyzed for discharges with mechanical thrombectomy. Data was analysed in two sections (Jan 2014-Oct 2015 and Oct 2015-Dec 2016) due to transition of US hospitals from ICD version 9 to 10 in Oct 2015. Multi-variable logistic regression was used to study effect of time (in 3 month periods), patient age and sex, concurrent thrombolysis, insurance status, hospital teaching status and hospital thrombectomy case volume on odds of death and discharge home. Results: During both time periods, the proportions of IS patients receiving thrombectomy increased markedly (Table 1). A temporal trend towards fewer patients being discharged home was seen over the last 15 months studied (Table 2, Figure 1). Older age and lower thrombectomy case volume were associated with increased odds of death and decreased odds of discharge home during both time periods (Table 2). Conclusion: The recent decreasing trend in proportion of patients being discharged to home after thrombectomy may reflect less selective and more aggressive therapy of IS and warrants further study.
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