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REGIONAL DIFFERENCES IN CLINICAL OUTCOMES AND RESOURCE UTILIZATION AFTER ACUTE ISCHEMIC STROKE HOSPITALIZATIONS IN THE UNITED STATES
2080 JACC March 21, 2017 Volume 69, Issue 11
Vascular Medicine REGIONAL DIFFERENCES IN CLINICAL OUTCOMES AND RESOURCE UTILIZATION AFTER ACUTE ISCHEMIC STROKE HOSPITALIZATIONS IN THE UNITED STATES Poster Contributions Poster Hall, Hall C Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m. Session Title: Vascular Medicine: Aortic and Peripheral Artery Diseases Abstract Category: 40. Vascular Medicine: Non Coronary Arterial Disease Presentation Number: 1298-351 Authors: Nilay Kumar, Neetika Garg, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
Background: Regional differences in acute ischemic stroke (AIS) incidence and mortality are well known. There is a paucity of nationally representative data on regional differences in outcomes after AIS hospitalization in the US.
Methods: We used the 2011 – 2013 National Inpatient Sample to include all hospitalization with a primary diagnosis of AIS. Outcome of interest included in-hospital mortality and length of stay (LOS) and cost dichotomized at median. Multivariate logistic models were used to ascertain differences in outcomes. Results: There were a total of 1.36 million AIS hospitalization in the US from 2011 – 2013. Mean age was 70.8 years and 52% were females. Patients in the Northeast (NE) were significantly older (mean age 72.2 years, p<0.001 for NE vs. MW, S or W in pairwise comparisons). Case fatality rate was significantly higher in the NE (4.9%) compared with MW (4.3%) and S (4.4%), p<0.001 for pairwise comparison. This difference became nonsignificant after adjusting for patient characteristics, illness severity and care practices. LOS was highest in the NE while cost was highest in the West.
Conclusions: There were significant regional differences in case fatality, LOS and cost in a nationally representative contemporary cohort of AIS hospitalization in the US. These differences were only partially explained by differences in patient characteristics and illness severity. Further investigation is warranted to understand the reasons for differences in AIS hospitalization outcomes. Regional differences in outcomes Northeast Midwest South West (n=243,489) (n=302,981) (n=557,226) (n=257,033) In-hospital mortality Unadjusted Ref 0.85 (0.79 - 0.92; <0.001) 0.89 (0.83 - 0.95; 0.001) 0.93 (0.86 - 1.01; 0.07) Adjusted Ref 0.92 (0.84 - 1.01; 0.10) 1.00 (0.91 - 1.08; 0.96) 0.91 (0.82 - 1.00; 0.06) LOS >=4 days Unadjusted Ref 0.73 (0.69 - 0.76; <0.001) 0.85 (0.82 - 0.89; <0.001) 0.61 (0.58 - 0.64; <0.001) Adjusted Ref 0.71 (0.67 - 0.75; <0.001) 0.81 (0.77 - 0.85; <0.001) 0.56 (0.52 - 0.59; <0.001) Hospital cost>= $8,664 Unadjusted Ref 0.65 (0.58 - 0.72; <0.001) 0.51 (0.46 - 0.56; <0.001) 1.15 (1.02 - 1.30; 0.02) Adjusted Ref 0.66 (0.55 - 0.74; <0.001) 0.48 (0.43 - 0.53; <0.001) 1.19 (1.05 - 1.36; 0.008) Table: Numbers in cells represent odds ratios (95% CI; p-value). All adjusted models include age, sex, race, atrial fibrillation, hypertension, thrombolysis, endovascular thrombectomy, intubation, tracheostomy, mechanical ventilation, cardiopulmonary resuscitation, hemodialysis, gastrostomy and enteral/parenteral nutrition, APR-DRG mortality risk score, charlson comorbidity index (CCI), socioeconomic status and hospital characteristics.
Vascular Medicine REGIONAL DIFFERENCES IN CLINICAL OUTCOMES AND RESOURCE UTILIZATION AFTER ACUTE ISCHEMIC STROKE HOSPITALIZATIONS IN THE UNITED STATES Poster Contributions Poster Hall, Hall C Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m. Session Title: Vascular Medicine: Aortic and Peripheral Artery Diseases Abstract Category: 40. Vascular Medicine: Non Coronary Arterial Disease Presentation Number: 1298-351 Authors: Nilay Kumar, Neetika Garg, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
Background: Regional differences in acute ischemic stroke (AIS) incidence and mortality are well known. There is a paucity of nationally representative data on regional differences in outcomes after AIS hospitalization in the US.
Methods: We used the 2011 – 2013 National Inpatient Sample to include all hospitalization with a primary diagnosis of AIS. Outcome of interest included in-hospital mortality and length of stay (LOS) and cost dichotomized at median. Multivariate logistic models were used to ascertain differences in outcomes. Results: There were a total of 1.36 million AIS hospitalization in the US from 2011 – 2013. Mean age was 70.8 years and 52% were females. Patients in the Northeast (NE) were significantly older (mean age 72.2 years, p<0.001 for NE vs. MW, S or W in pairwise comparisons). Case fatality rate was significantly higher in the NE (4.9%) compared with MW (4.3%) and S (4.4%), p<0.001 for pairwise comparison. This difference became nonsignificant after adjusting for patient characteristics, illness severity and care practices. LOS was highest in the NE while cost was highest in the West.
Conclusions: There were significant regional differences in case fatality, LOS and cost in a nationally representative contemporary cohort of AIS hospitalization in the US. These differences were only partially explained by differences in patient characteristics and illness severity. Further investigation is warranted to understand the reasons for differences in AIS hospitalization outcomes. Regional differences in outcomes Northeast Midwest South West (n=243,489) (n=302,981) (n=557,226) (n=257,033) In-hospital mortality Unadjusted Ref 0.85 (0.79 - 0.92; <0.001) 0.89 (0.83 - 0.95; 0.001) 0.93 (0.86 - 1.01; 0.07) Adjusted Ref 0.92 (0.84 - 1.01; 0.10) 1.00 (0.91 - 1.08; 0.96) 0.91 (0.82 - 1.00; 0.06) LOS >=4 days Unadjusted Ref 0.73 (0.69 - 0.76; <0.001) 0.85 (0.82 - 0.89; <0.001) 0.61 (0.58 - 0.64; <0.001) Adjusted Ref 0.71 (0.67 - 0.75; <0.001) 0.81 (0.77 - 0.85; <0.001) 0.56 (0.52 - 0.59; <0.001) Hospital cost>= $8,664 Unadjusted Ref 0.65 (0.58 - 0.72; <0.001) 0.51 (0.46 - 0.56; <0.001) 1.15 (1.02 - 1.30; 0.02) Adjusted Ref 0.66 (0.55 - 0.74; <0.001) 0.48 (0.43 - 0.53; <0.001) 1.19 (1.05 - 1.36; 0.008) Table: Numbers in cells represent odds ratios (95% CI; p-value). All adjusted models include age, sex, race, atrial fibrillation, hypertension, thrombolysis, endovascular thrombectomy, intubation, tracheostomy, mechanical ventilation, cardiopulmonary resuscitation, hemodialysis, gastrostomy and enteral/parenteral nutrition, APR-DRG mortality risk score, charlson comorbidity index (CCI), socioeconomic status and hospital characteristics.