Abstract 47: Outcomes In Acute Ischemic Stroke Patients Treated With Endovascular Thrombectomy Before And After 2015: An Analysis Of The National Inpatient Sample

Abstract

Background: Endovascular thrombectomy (EVT) demonstrated superiority to medical management in the 2015 trials. We sought to compare outcomes in acute ischemic stroke (AIS) treated with EVT before and after 2015. Methods: A query of the 2000-2019 National Inpatient Sample was performed for patients admitted with AIS (ICD9 433, 43401, 43411, 43491, ICD-10 I63). Demographics, comorbidities, and outcomes were identified. Univariate analysis with t-tests or chi-square performed as appropriate. A 1:1 nearest neighbor propensity score matched cohort was generated. Variables with standardized mean differences >0.1 used in multivariate regression to generate adjusted odds ratios (AOR)/β-coefficients for EVT on outcomes. Significance set at an alpha level of <0.001. All analysis performed in R version 4.1.3. Results: A total of 10,415,286 patients with AIS were identified; 149,367 (1.4%) underwent EVT. Among the EVT cohort, 35,562 patients were treated before 2015 (23.8%) vs. 113,805 (76.2%) after. EVT patients after 2015 were more likely to be younger, on private insurance, treated at large urban nonteaching hospitals, had lower Elixhauser Comorbidity Scores (14.71 ± 9.15 vs. 16.21 ± 9.17; p<0.001) but increased markers of stroke severity such as higher rates of ventilator use, paresis, seizures, craniotomy and tracheostomy placement (all p<0.001). After propensity matching, EVT patients after 2015 were more likely to be discharged home (AOR 1.35, 95%CI:1.24-1.47), have increased hospital charges ($40828.79; 95%CI: $36391.76-45265.81), had shorter hospital stay (-0.74 days, 95%CI: -0.99 - -0.48)(all p<0.001), with no difference in In-hospital mortality. Conclusions: This 20-year nationally representative propensity matched analysis of AIS patients shows that outcomes after EVT continue to improve following the landmark 2015 publications, with a higher chance of favorable outcome, lower hospital charge and shorter hospital stay compared to before 2015.