Abstract
Background: There have been well described regional variations in treatment offered for acute ischemic strokes (AIS) but there is a paucity of data regarding such variations in outcomes in patients treated with mechanical thrombectomy (MT) in the US. Objective: To assess regional variations of in-hospital mortality among patients treated with MT for AIS in the US. Methodology: Nationwide Inpatient Sample database used to gather information on patients receiving MT for AIS from 4 US regions [Northeast (NE), Midwest (MW), South (S), & West (W)] from 2006 to 2014. Independent predictors of in-hospital mortality after stroke treated with MT were evaluated using multivariable logistic regression. Results: 6049 patients received MT for AIS during the study period (NE 20%; MW 25%; S 31%; W 24%). No significant difference was noted in age, gender, and Charlson comorbidity index between the regions. Adjusted multivariable logistic regression analysis revealed odds ratio (OR) for in-hospital mortality of 0.72 (95% CI 0.54-0.97) in MW, 0.71 (95% CI 0.54-0.94) in W, and 0.85 (95% CI 0.65-1.12) in S compared to NE. Other factors associated with greater in-hospital mortality are males (female OR 0.84; 95% CI 0.72-0.99), older age [ORs for 45-64 y: 1.5 (95% CI 1.1-2.2); 65-84 y: 2.1 (95% CI 1.4-2.9); ≥85y: 2.9 (95% CI 1.9-4.5) (reference: <45 y)], weekend admissions (OR 1.13; 95% CI 1.11-1.55), and shorter LOS (OR 0.89 per 1 day increase in LOS; 95% CI 0.86-0.91). Patient’s income and ethnicity, hospital size, and academic status of the treating hospital were not associated with in-hospital mortality. Conclusions: In the United States, rates of in-hospital mortality were significantly lower in patients receiving MT in the MW and W compared to the NE, a difference not explained by demographics or comorbidities. The NE has greater population density and more traffic delays vs. other regions, which may prolong time to recanalization and negatively impact the outcome. Closer analysis of regional variations in time sensitive quality measures of acute stroke care and complication rates could help clarify such findings.
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