Clinical outcome and cost effectiveness of acute ischemic stroke transfers for endovascular reperfusion therapy from geographically distant counties: Stroke transfer outcomes.

Autor: Ray B; Division of Neurocritical Care, Department of Neurology and Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA; Peter O'Donnell Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA. Electronic address: Bappaditya.Ray@UTSouthwestern.edu., Mathews EP; Division of Neurocritical Care, Department of Neurology and Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA; Peter O'Donnell Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA. Electronic address: Essie.Mathews@UTSouthwestern.edu., Hernandez RS; Division of Statistical Planning and Analysis, Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Peter O'Donnell Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA. Electronic address: Roberto.Hernandez@UTSouthwestern.edu., Glaser KR; Division of Neurocritical Care, Department of Neurology and Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA; Peter O'Donnell Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA. Electronic address: Kimberly.Glaser@UTSouthwestern.edu., Washington HH; Division of Neurocritical Care, Department of Neurology and Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA; Peter O'Donnell Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA. Electronic address: Heather.Hasan@UTSouthwestern.edu., Salter A; Division of Statistical Planning and Analysis, Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Peter O'Donnell Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA. Electronic address: Amber.Salter@UTSouthwestern.edu., Olson DM; Division of Neurocritical Care, Department of Neurology and Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA; Peter O'Donnell Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA. Electronic address: Daiwai.Olson@UTSouthwestern.edu., Aiyagari V; Division of Neurocritical Care, Department of Neurology and Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA; Peter O'Donnell Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA. Electronic address: Venkatesh.Aiyagari@UTSouthwestern.edu.
Jazyk: angličtina
Zdroj: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association [J Stroke Cerebrovasc Dis] 2024 Nov; Vol. 33 (11), pp. 107981. Date of Electronic Publication: 2024 Aug 31.
DOI: 10.1016/j.jstrokecerebrovasdis.2024.107981
Abstrakt: Objectives: Endovascular reperfusion therapy (EVT) for acute ischemic stroke (AIS) with large vessel occlusion (LVO) has resulted in increased patient transfers to comprehensive stroke centers (CSCs). Clinical outcomes including the financial impact of these transfers from geographically dispersed population are lacking. Hence, we studied outcomes and cost-effectiveness of stroke transfers from remote areas.
Materials and Methods: We used a 3-year cohort of AIS patients transferred from geographically dispersed counties (<100 mi., 101-200 mi., and >200 mi.). A 3-month modified Rankin scale (mRS) score of 0-2 defined a favorable clinical outcome. Cost-effectiveness is studied by calculating the incremental cost effectiveness ratio, using hospital costs reimbursed data and utility-weighted (UW)-mRS.
Results: Among 172 patients transferred for EVT, patients transferred from nearby counties were more likely to undergo intervention compared to other counties (56.9 % vs. 36.7 % vs. 49.2 % p = .11). Irrespective of proximity (in mi.) to CSC [21.5 (14-56.3)] vs. 185 (137-185) vs. 349 (325-355)], there was a similar delay (in min.) to arrival from all locations [321.5 (244-490), 366 (298-432), and 460 (385-554.5) respectively], but no statistically significant differences in favorable outcomes (18.0 %, 34.1 %, and 22.2 %, respectively, p = .41). Patients undergoing EVT had higher hospital costs reimbursed compared to non-EVT patients [$37,303 (25,745-40,658) vs. $14,008 (8,640-21,273) respectively, p < .001] and no statistically significant difference in UW-mRS [0.32 (0.06-0.56) vs. 0.06 (0-0.56), p = .30].
Conclusions: Our study identifies a need for targeted interventions to improve community awareness and optimize systems of care to improve outcomes and cost-effectiveness of EVT.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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