Abstract
Background: surgical decompressive techniques have shown a significant reduction in mortality in acute ischemic stroke (AIS) compared to medical treatment. Limitations in acute stroke therapies have been described among Hispanic and African American populations compared to other races. Objective: To investigate trends in hemicraniectomy among hospitalized patients in the United States, with emphasis on treatment by race. Methods: The Nationwide Inpatient Sample was queried from 2006 to 2015 for all patients older than 18-years of age with a primary diagnosis of AIS who had procedure codes for craniotomy excluding posterior fossa territory infarctions. Frequency of hemicraniectomy in patients with AIS hospitalization was determined. We utilized multivariable logistic regression analyses to study the independent association between race and trends in hemicraniectomy. Results: A population of patients with AIS (n=715649) was analyzed. The queried was divided by hemicraniectomy (n=1514) and no hemicraniectomy (n=714135). Demographic variables included age, gender (male or female), race (White, African American, Hispanic, others) and payer status (Medicare, Medicaid, private, other). In multivariable analysis, adjusted for potential confounders the odds to have a hemicraniectomy was greatest in the 18-44 age group [age 45-64 (Odds Ratio [OR]: 0.49, 95% CI: 0.42-0.58); age 65-84 (OR: 0.16, 95% CI: 0.13-0.20); age ≥85 (OR: 0.007, 95% CI: 0.003-0.01)]. Medicare insurance [Medicaid (OR: 1.5, 95% CI: 1.2-1.9); Private insurance (OR: 1.7, 95% CI: 1.43-2.03)]; urban teaching hospital (OR: 1.57, 95% CI: 3.63-12.05); prior administration of intravenous tPA (OR: 2.64, 95% CI: 2.21-3.16); being admitted after 2009 (2009-2011 OR: 1.68, 95% CI: 1.13-2.13; 2012-2014 OR: 1.81, 95% CI: 1.44-2.27) and coma status (OR: 15.8, 95% CI: 13.1-19.2) were found to increase the likelihood of having a hemicraniectomy after an AIS. The Hispanic population was more likely to have a hemicraniectomy when compared to White (OR: 1.28, 95% CI: 1.02-1.60). Conclusions: Over the last decade in the United States, being Hispanic was independently associated with an increased likelihood to have a hemicraniectomy.
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
