Key result
Between 2011 and 2017, endovascular therapy for acute ischemic stroke was associated with a significant decrease in all-cause 365-day readmission from 47.5% to 36.7% (p<0.05).
Why the study?
Few studies have examined trends in clinical and economic outcomes of patients with acute ischemic stroke who receive endovascular therapy in the real-world setting.
Cohort (n=3,411)
Yes
Clinical and economic outcomes, including length of stay, readmission rates, and total costs, improved significantly for patients undergoing endovascular therapy for acute ischemic stroke between 2011 and 2017 in the US.
May reduce long-term readmissions after acute ischemic stroke; hypothesis-generating and requires prospective confirmation before practice change.
BACKGROUND: Few studies have examined the trends in clinical and economic outcomes of patients with acute ischemic stroke (AIS) who receive endovascular therapy (ET) in the real-world setting. OBJECTIVE: To evaluate characteristics and trends in clinical and economic outcomes among commercially insured patients with AIS undergoing ET between 2011 and 2017. METHODS: Patients with AIS undergoing ET from January 1, 2011 to June 30, 2017 were identified from administrative claims contained in the IBM MarketScan Commercial and Medicare Supplemental databases. The Mann-Kendall trend test was performed to examine clinical and economic trends.Between 2011 and 2017, 3411 patients (mean age 62.85±15 years) with a primary diagnosis of AIS underwent ET (coverage: Commercial 59%, n=2008; Medicare Supplemental 41%, n=1403). In the Commercial cohort, discharge to home increased significantly (from 29.54% to 39.18%, p<0.05). Length of stay declined significantly among the overall cohort (from 10.96 to 9.05 days, p<0.01) and the Medicare Supplemental cohort (from 10.03 to 8.43 days, p<0.05). All-cause 365-day readmission decreased significantly among the overall cohort (from 47.5% to 36.7%, p<0.05) and the Commercial cohort (from 51.54% to 36.43%, p<0.05) but remained unchanged in the Medicare Supplemental cohort. While index procedure cost did not change significantly ($93 955 to $87 906, p=0.8806), total cost significantly declined in the overall cohort (from $166 922 to $130 678, p<0.05). CONCLUSIONS: Although with some variation across the samples studied, outcomes including discharge to home, length of stay, readmission, and total cost associated with endovascular stroke therapy seemed to have improved between 2011 and 2017. Index admission cost remained unchanged.
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Rai et al. (2019) conducted a cohort in Acute ischemic stroke (n=3,411). Endovascular therapy vs. Earlier time period (2011) was evaluated on All-cause 365-day readmission (p=<0.05). Between 2011 and 2017, endovascular therapy for acute ischemic stroke was associated with a significant decrease in all-cause 365-day readmission from 47.5% to 36.7% (p<0.05).
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