Inverse National Trends in Decompressive Craniectomy Versus Endovascular Thrombectomy for Stroke. (1st September 2019)

• Record Type: Journal Article
• Authors: Khattar, Nicolas K; Ugiliweneza, Beatrice; Sharma, Mayur; Fortuny, Enzo; Adams, Shawn William; Meyer, Kimberly S; Boakye, Maxwell; James, Robert F; Ding, Dale
• Is Part Of: Neurosurgery. Volume 66(2010)Supplement 1
• Publication Date: 2019-09-01
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyz310_309
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: Endovascular thrombectomy (ET) for acute large vessel occlusion reduces infarct size, and it should hypothetically decrease the incidence of major ischemic strokes requiring decompressive craniectomy (DC). The aim of this retrospective cohort study is to determine trends in the utilization of ET versus DC for stroke in the United States over a 10-yr span. METHODS: We extracted data from the Nationwide Inpatient Sample (NIS) using ICD-9/10 codes for the time period 2006 to 2016. Patients with a primary diagnosis of stroke and a concurrent procedure code for ET or DC were included. Baseline demographics, outcomes and hospital charges were analyzed. RESULTS: The study cohort comprised 187 355 patients diagnosed with stroke who underwent either ET or DC. The number of ET- or DC-treated stroke patients increased by 266% from 2006 to 2016. During the study period, the ET utilization rate increased (2.7% in 2006 to 68.6% in 2016, P < .0001) and the DC utilization rate decreased (97.3% in 2006 to 31.4% in 2016, P < .0001). In 2015, the utilization rate of ET (50.2%) exceeded that of DC (49.8%). ET-treated patients had shorter durations of hospital stay (mean 8.8 vs 16.8 days, P < .0001), decreased mortality (16.2% vs 19.3%), higher likelihood of discharge home (27.1% vs 24.1%, P < .0001), and lower hospital charges (mean $189, 724 vs $261, 314, P < .0001) CONCLUSION: We identified an inverse relationship between national trends in increasing ET and diminishing DC utilization for stroke treatment over a recent decade. Although direct causation cannot be inferred, our findings suggest that ET curtails the necessity for DC.