Abstract WMP50: Disparities of Interhospital Transfer for Mechanical Thrombectomy in Acute Stroke in US

Abstract

Introduction: A large proportion of mechanical thrombectomies (MT) in acute stroke include patients transferred from an outside hospital to thrombectomy capable centers. However, patient characteristics associated with the odds of transfer is unknown. We explored the US national claims database to explore predictors of interfacility transfer in MT hospitalizations using a nationally representative sample. Methods: National Inpatient Sample database was retrospectively explored from 2016 to 2020 for stroke hospitalizations with EVT. The primary outcome was transfer status from the presenting emergency department of MT-capable hospital. Multivariable logistic regression models with multiple robustness checks were performed to determine patient characteristics with the odds of transfer. Results: This study included 100,865 patients with MT, of whom 32,685 patients (32.4%) were transferred (median [IQR] age, 71 [60-81] years; 16775 women [51.2%]; 23090 White individuals [74.9%]; 3715 Black individuals [12.1%]; 1875 Hispanic individuals [6.1%]; 895 Asian individuals [2.9%]). White race, higher baseline NIHSS, hospital size and status (urban teaching vs rural), and hospital location were independent predictors of interfacility transfer for MT. Conclusion: Nearly one in 3 MTs in the US is performed in patients presenting following transfer from another acute care hospital. Analysis of population level data utilizing the National Inpatient Sample database shows disparities in the transfer of patients with minority backgrounds (Black, Hispanic, Asian) for MT. Urban teaching centers, larger hospitals, higher baseline NIHSS, and hospital location (northeast and midwest) were more likely to receive Interhospital MT transfers regardless of race.