Abstract 126: Inpatient Rehabilitation Facility Disposition Improves Odds For Good Clinical Outcome After Endovascular Stroke Reperfusion Therapy

Abstract

INTRO: A person with stroke has improved outcomes with post-acute care in an inpatient rehabilitation facility (IRF) compared to those who are discharged to a skilled nursing facility (SNF). However, this research was conducted in an era before acute stroke treatment was widely implemented. Endovascular reperfusion reduces ischemic stroke volume; however treatment effect may be diluted by discharge disposition. In this analysis, we hypothesize that patients will have better 90 day outcomes if they are discharged to a IRF or home compared to a SNF. METHODS: Subjects were identified from a prospective database tracking clinical outcomes of patients treated with endovascular reperfusion from a single primary care stroke center. Data included discharge disposition, NIHSS, THRIVE, HIAT-2, & APACHE II scores, and successful reperfusion. Univariate analysis was performed to assess predictors of good clinical outcome as defined by 90 day modified Rankin scores (mRS) ≤ 2. A binary logistic regression model was used to determine the impact placement to IRF versus a SNF on clinical outcomes. RESULTS: 177 subjects were included in the analyis; mean age was 66±14 and median NIHSS was 20. Modified APACHE II, NIHSS, THRIVE, & HIAT-2 scores were not different between the two groups Discharge dispositions included: 35(19.8%)home, 38(21.5%) IRF, 47(26.6%)SNF and 57(32.3%) died/went to hospice. Of the 85 patients discharged to SNF or IRF, only 26% of patients discharged to SNF compared to 50% to IRF achieved a good clinical outcome (p-value <0.03). In binary logistic regression modeling, after adjusting for age, infarct volume, pre-treatment ASPECT & NIHSS scores, and modified APACHE II score, disposition to SNF was significantly associated with a lower probability of achieving a mRS of 0-2 at 90 days, OR 3.31(95%CI 1.06-9.62, p<0.04). CONCLUSIONS: In our study, subjects discharged to SNF and IRF after thrombectomy have similar medical and neurological severity at admission and similar final infarct volumes at discharge. Despite these similarities, patients discharged to SNF had a significantly lower probability of achieving a good neurological outcome. Further study is required to determine if IRF could be considered in more patients to improve clinical outcomes.