Neurology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.
Neurology, Neurosurgery, and Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
J Neurointerv Surg. 2020 Apr;12(4):356-362. doi: 10.1136/neurintsurg-2019-015019. Epub 2019 Aug 23.
Following widespread acceptance of endovascular therapy (ET) for large vessel occlusion stroke in 2015, we assessed nationwide utilization of revascularization for acute ischemic stroke (AIS).
We utilized the 2013-2016 Healthcare Cost and Utilization Project Nationwide Readmissions Database. We identified AIS admissions, treatment with intravenous thrombolysis (IVT), ET, and vascular risk factors using International Classification of Disease Clinical Modification codes. Main predictor of outcome was the time period of index admission ('pre-endovascular era (pre-EA)' January 2013-January 2015 and 'endovascular era (EA)' February 2015- December 2016). We calculated the proportion of AIS admissions in which, first, VT and second, ET was performed. Among patients treated with ET, we examined the association between era and discharge disposition, in-hospital mortality during index admission, and 30-day readmission.
There were 925 363 index AIS admissions before the EA and 857 347 during. A higher proportion of AIS patients received IVT (8.4% vs 7.8%) and ET (2.6% vs 1.3%) in the EA. Although length of stay (LOS) was shorter in the EA (5.70 vs 6.80 days), total charges were greater ($56 691 vs $53 878), and admissions were more often to a metropolitan hospital (65.2% vs 57.2%). Among those treated with ET, a smaller proportion received IVT (29.7% vs 44.9%), LOS was substantively shorter (9.75 vs 12.76 days), and patients had a lower odds of discharge home.
The utilization of ET has doubled in the EA but ET remains underutilized. ET is predominantly provided at metropolitan teaching hospitals and associated with higher charges despite shorter LOS and unchanged in-hospital mortality.
2015 年广泛接受血管内治疗（ET）治疗大血管闭塞性脑卒中后，我们评估了急性缺血性脑卒中（AIS）的再血管化治疗的全国利用率。
我们利用了 2013-2016 年医疗保健成本和利用项目全国再入院数据库。我们使用国际疾病分类临床修正代码确定 AIS 入院、静脉溶栓（IVT）、ET 和血管危险因素。主要预后预测因素是索引入院的时间段（“血管内治疗前时代（EA 前）”，2013 年 1 月至 2015 年 1 月和“血管内治疗时代（EA）”，2015 年 2 月至 2016 年 12 月）。我们计算了首先进行 IVT 和其次进行 ET 的 AIS 入院比例。在接受 ET 治疗的患者中，我们检查了时代与出院安置、住院期间死亡率以及 30 天再入院之间的关联。
在 EA 之前有 925363 例指数 AIS 入院，而在 EA 期间有 857347 例。在 EA 中，更多的 AIS 患者接受了 IVT（8.4%比 7.8%）和 ET（2.6%比 1.3%）。尽管 EA 中的住院时间（LOS）更短（5.70 天比 6.80 天），但总费用更高（56691 美元比 53878 美元），并且更多的入院发生在大都市医院（65.2%比 57.2%）。在接受 ET 治疗的患者中，接受 IVT 的比例较小（29.7%比 44.9%），LOS 显著缩短（9.75 天比 12.76 天），出院回家的可能性降低。
EA 中 ET 的使用率增加了一倍，但 ET 的使用率仍然较低。ET 主要在大都市教学医院提供，尽管 LOS 缩短且住院死亡率不变，但费用更高。
