Abstract TP30: Mechanical Thrombectomy in Acute Ischemic Stroke: Etiology and Trends of Readmissions in a National Population-based Cohort Study (2010-2014)

Abstract

Background: Our primary aim was to estimate national rates of preventable readmissions after Mechanical thrombectomy in Acute ischemic stroke (AIS) using National readmission database. Understanding the causes associated with 30-day readmissions following mechanical thrombectomy (MT) is critical to reduce the cost and improving the quality of life in AIS patients. Methods: Nationwide Readmissions Database (NRD) from 2010-14 was utilized to identify AIS using appropriate ICD-9CM codes in primary diagnosis fields. MT was identified by ICD9 procedure code 39.74 and IVT by 99.10 in any procedural field. Admissions within 30 day of index admission were considered as early readmission. Readmission causes were identified by ICD 9 CM code in primary diagnosis field of readmissions. P values for trends were generated by Cochrane-Armitage test for categorical variables and simple linear regression for continuous variables. Results: We identified 20,772 AIS patients who underwent MT, Mean age was 68 years and procedures were distributed equally in both genders. MT hospitalization progressively increased from 2,533 in 2010 to 5,598 in 2014, with similar rising trends in 30-day readmission from 272 in 2010 to 597 in 2014. Most patients received MT at large (85.9%) and teaching (83%) hospitals. 2237 (10.8%) patients were readmitted within 30 days. 50% of all readmissions were within 11 days of discharge from index admission. Common causes of readmission were neurological (22.8%), cardiac (21.5%), infections (13.3%), kidney or urinary causes (9%), pulmonary causes (8.5%), bleeding (4.8%). Major neurological causes were ischemic stroke (11.8%), intracerebral hemorrhage (3.7%) and transient ischemic attack (1.2%). Heart failure (4.8%), atrial were the most common cardiac causes of readmission. Conclusion: 1 in 10 patients who underwent MT for AIS were readmitted; 50% of them in first 11 days; due to neurological and cardiac causes. Our study could help early identification of high risk patients and aid in allocation of resources to reduce readmissions.