Thrombectomy Results in Reduced Hospital Stay, More Home-Time, and More Favorable Living Situations in DEFUSE 3. Issue 9 (September 2019)

• Record Type: Journal Article
• Authors: Tate, William J.; Polding, Laura C.; Kemp, Stephanie; Mlynash, Michael; Heit, Jeremy J.; Marks, Michael P.; Albers, Gregory W.; Lansberg, Maarten G.
• Is Part Of: Stroke. Volume 50:Issue 9(2019)
• Publication Date: 2019-09
• Subjects: hospices -- hospital -- quality of life -- magnetic resonance imaging -- thrombectomy; Cerebrovascular disease -- Periodicals; Cerebral circulation -- Periodicals; 616.81
• DOI: 10.1161/STROKEAHA.119.025165
• Languages: English
• ISSNs: 0039-2499

Abstract

Abstract : Background and Purpose—: The DEFUSE 3 trial (Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke) demonstrated that endovascular thrombectomy in the 6- to 16-hour time window improves functional outcomes of patients with evidence of salvageable tissue on baseline computed tomography or magnetic resonance imaging. The purpose of this study is to assess the effect of endovascular therapy on length of hospital stay, home-time during the first 3 months poststroke, and living situation poststroke in DEFUSE 3. Methods—: Duration of hospital stay and home-time (number of days during the 90-day poststroke period that the patient resides in their own home or in that of a relative) were compared between treatment groups using the Wilcoxon rank-sum test. Patient living situation was assessed at discharge, 30 days, and 90 days on an ordinal 4-point scale (home, acute rehabilitation unit, institutionalized care, or hospice/death) and differences between groups were analyzed using the Cochran-Armitage trend test. Results—: Median length of hospital stay was 9.1 (interquartile range, 6.2–15.0) days in the medical group versus 6.5 (interquartile range, 3.7–9.3) days in the endovascular group ( P <0.001). Median home-time during the first 90 days after stroke was 0 (interquartile range, 0–53) days in the medical group versus 55 (interquartile range, 0–83) days in the endovascular group ( P <0.001). The endovascular group had more favorable living situations at time of discharge ( P <0.001), 30 days ( P <0.001), and 90 days ( P <0.001) poststroke. Conclusions—: Endovascular thrombectomy resulted in reduced hospital stay, more home-time, and more desirable living situations in the 90 days after stroke. These results provide evidence that endovascular therapy in the delayed time window can improve quality of life for stroke patients and reduce healthcare costs. Clinical Trial Registration—: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02586415.