Abstract P527: Temporal Trend of Mechanical Thrombectomy Utilization in Treatment of Perioperative Ischemic Stroke Following Elective Inpatient Surgery in the United States

Abstract

Background: Perioperative ischemic stroke (PIS) significantly increases morbidity and mortality in patients undergoing elective surgery. Mechanical thrombectomy (MT) can improve outcomes of ischemic stroke, but the frequency and trend of its utilization for treatment of PIS is not studied. Methods: In this retrospective observational study using the Premier Healthcare Database, we identified adults who underwent elective inpatient surgery from 2008 to 2018. Patients with PIS were identified using the established International Classification of Diseases (ICD) ninth revision codes or equivalent ICD, tenth revision codes. Cases that underwent MT were further identified using established ICD9 and ICD10 procedure codes. Descriptive statistics were used to compare patient and center level characteristics between patients who received MT versus did not after PIS. Results: Of 6,349,668 patients with elective inpatient surgery, 12,507 (0.2%) had PIS. The mean age (and standard deviation) of these patients was 69.5 (11.7) years, and 48.8% were female. MT was used in 1.7% of all patients with PIS and its use increased from 0.0% in 3 rd quarter, 2008 to 4.4% in 4 th quarter, 2018. There was a significant increase in the use of MT after 3 rd quarter, 2015 when MT use was incorporated in acute stroke treatment guidelines (1.14% before 3 rd quarter, 2015 versus 3.07% after; p<0.0001). Amongst patients with PIS, patients who received mechanical thrombectomy were more likely to have their surgery performed at a teaching institute (67.3% versus 53.9%). Conclusion: Although there was a significant increase in rates of utilization of MT, rates of utilization remain low, especially in non-teaching hospitals. This highlights improvements in the management of perioperative ischemic strokes and further opportunities to improve outcomes.