Introduction: Endovascular therapy (EVT) has been introduced for the treatment of acute ischemic stroke. Data regarding the therapeutic benefit of EVT, including mechanical thrombectomy, have been called into question after publication of the IMS III trial results. Hence its utilization in hospitals is controversial and reimbursement is now in question.
Methods: We analyzed data from the Nationwide Inpatient Sample (NIS) from 2008 to 2010 for the prevalence of intracranial endovascular procedures for ischemic stroke. Admission and discharge characteristics were compared between hospitals performing EVT with those not performing EVT. In-hospital mortality was analyzed in a multivariable model, adjusted for patient’s age and disease severity.
Results: 335,766 ischemic stroke cases were identified; 83% of these were treated at institutions that offered EVT. Patients at hospitals with EVT had significantly greater disease severity and a higher risk of mortality in comparison to cases treated at hospitals without EVT (P<.001). The length of stay and total hospital charges were significantly greater for patients treated at centers with EVT (P<.001). But a significantly greater percentage of these patients were discharged home under self-care (P<.001). In addition, a multivariable model, adjusted for age and disease severity, found admission to a hospital without EVT to raise the odds of mortality by 17% (P<.001) (95% Odds-Ratio CI: 1.132-1.217).
Conclusions: Treatment at an institution with EVT appears to provide advantages to long-term patient health. However, this is associated with significantly greater total hospital charges. Analysis was performed from 2008-2010, reflecting the period just after approval of the Penumbra aspiration device (Penumbra Inc., Alameda, CA) but prior to the FDA approval of stent-retrievers. As this next generation of stent-retriever technology shows initial promise for offering safer and faster recanalization than previous generation devices, it will remain important to study their effect on patient outcome and cost.
Patient Care: This research addresses the controversy over endovascular therapy for ischemic stroke and provides nationwide evidence of the costs and benefits of its inclusion at hospitals.
Learning Objectives: Participants should be able to: 1) Describe the charges incurred by hospitals that offer endovascular therapy for acute ischemic stroke, and 2) Discuss the benefits of presenting to a hospital that offers endovascular therapy after suffering from an acute ischemic stroke.