Abstract TP360: Does Weekend Admission for Intravascular Thrombolysis Post-Acute Ischemic Stroke Associated With Worse Short-Term Outcomes? A 5-Years Us Experience

Abstract

Background: No large-scale study available to establish ‘weekend effect’ of higher in-hospital mortality and 30-day readmissions after admission for post-Acute ischemic stroke (AIS) thrombolysis. Our objective was to determine short term outcomes and its trends associated with weekend vs weekday index hospitalization. Methods: Nationwide Readmissions Database (NRD) from 2010-14 was utilized to identify AIS using appropriate ICD-9CM codes in primary diagnosis fields. IVT was identified by ICD9 procedure code 99.10 in any procedural field. HCUP variable “aweekend” was used to identify weekend vs weekday admission and Cochrane-Armitage test was used to generate p value. Results: We identified 164,007 AIS patients undergoing IVT (Mean age=69.5 years,49.6% Female). Weekend admission (6,229 in 2010 to 11,156 in 2014) were associated with increasing trends of hospitalization for thrombolysis with a relative change of 78%. Weekend admissions were associated with overall higher 30-day readmissions (11.03% vs 10.8%), with decreasing trend from 11.5% (vs 12% weekdays) in 2010 to 10.5% (vs 10.3% weekdays) in 2014 with a relative decrease of 8.1% (vs 16.5%- weekdays) (p<0.001). Weekend admissions were associated with overall higher in hospital mortality 9.2% vs 9.03% as compared to weekdays, though exhibiting a decline from 10.9% to 7.5% (relative change -32.5%, p<0.001). Weekend admissions were associated with overall lower cost of hospitalization 25,929$ vs 26,523$ as compared to weekdays, though exhibiting a decline from 27,215$ to 24,613$ (relative change -10.5%, p<0.001). There is no significant difference in length of stay between weekend vs weekday admission (9days vs 9 days). Conclusion: Our study showed that weekend admissions for AIS patients undergoing IVT are associated with higher in-hospital mortality, 30-day readmission and lower cost of hospitalization. We speculate that better access of care on weekends will improve then outcome for patients getting IVT and reduce the healthcare burden associated with readmissions.