Abstract 3138: Hospitalization Costs for Acute Ischemic Stroke Patients Treated with Endovascular Embolectomy in the United States

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Waleed Brinjikji ◽  
David F Kallmes ◽  
Giuseppe Lanzino ◽  
Alejandro A Rabinstein ◽  
Harry J Cloft
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Hospital Costs ◽  
The United States ◽  
Group Code ◽  
Stroke Patients ◽  
Good Outcome ◽  
Major Complications ◽  
Hospitalization Costs ◽  
Related Group

Background and Purpose- It is important to know the costs for hospitalization for endovascular embolectomy patients so that comparisons can be made to payments to hospitals. Methods- Using the National Inpatient Sample, we evaluated the costs for hospitalization for patients treated with endovascular embolectomy in the United States from 2006-2008. The primary endpoint examined in this study was total hospital costs, and these were correlated with clinical outcome. Hospitalization costs were then compared with Medicare payments for their respective outcomes. MS-DRG 24 was the diagnostic related group code (DRG) for mechanical embolectomy with good outcome and MS-DRG 23 was the DRG code for mechanical embolectomy with major complications. Medicare payments were available at http://www.cms.hhs.gov . Results- A total of 3864 patients received endovascular embolectomy. 1649 patients were <65 years old and 2205 patients were ≥65 years old. Median hospital costs in 2008 dollars were $36,999 (IQR $26,662-$56,405) for patients with good outcome, $50,628 (IQR $33,135-$76,063) for patients with severe disability, and $35,109 (IQR $25,053-$62,621) for patients with mortality. Reimbursement in the year 2008 for DRG 24 (good outcome) was $22075 and reimbursement for DRG 23 (major complications) was $26639. Conclusions- Our study of the NIS shows that hospitalization costs in the United States for ischemic stroke patients treated with endovascular embolectomy are rather high, probably due to the serious nature of their illness. Medicare payments have not been adequate in reimbursing these hospitalizations. Further work is needed to ensure the future reconciliation of costs with payments.

scholarly journals Sex disparity in long-term stroke recurrence and mortality in a rural population in the United States

2020 ◽  
Vol 13 ◽  
pp. 175628642097189
Author(s):  
Clare Lambert ◽  
Durgesh Chaudhary ◽  
Oluwaseyi Olulana ◽  
Shima Shahjouei ◽  
Venkatesh Avula ◽  
...  
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Rural Population ◽  
The United States ◽  
Competing Risk ◽  
Stroke Recurrence ◽  
Composite Outcome ◽  
Stroke Patients ◽  
Central Pennsylvania ◽  
All Cause Mortality

Background: Several studies suggest women may be disproportionately affected by poorer stroke outcomes than men. This study aims to investigate whether women have a higher risk of all-cause mortality and recurrence after an ischemic stroke than men in a rural population in central Pennsylvania, United States. Methods: We analyzed consecutive ischemic stroke patients captured in the Geisinger NeuroScience Ischemic Stroke research database from 2004 to 2019. Kaplan–Meier (KM) estimator curves stratified by gender and age were used to plot survival probabilities and Cox Proportional Hazards Ratios were used to analyze outcomes of all-cause mortality and the composite outcome of ischemic stroke recurrence or death. Fine–Gray Competing Risk models were used for the outcome of recurrent ischemic stroke, with death as the competing risk. Two models were generated; Model 1 was adjusted by data-driven associated health factors, and Model 2 was adjusted by traditional vascular risk factors. Results: Among 8900 adult ischemic stroke patients [median age of 71.6 (interquartile range: 61.1–81.2) years and 48% women], women had a higher crude all-cause mortality. The KM curves demonstrated a 63.3% survival in women compared with a 65.7% survival in men ( p = 0.003) at 5 years; however, the survival difference was not present after controlling for covariates, including age, atrial fibrillation or flutter, myocardial infarction, diabetes mellitus, dyslipidemia, heart failure, chronic lung diseases, rheumatic disease, chronic kidney disease, neoplasm, peripheral vascular disease, past ischemic stroke, past hemorrhagic stroke, and depression. There was no adjusted or unadjusted sex difference in terms of recurrent ischemic stroke or composite outcome. Conclusion: Sex was not an independent risk factor for all-cause mortality and ischemic stroke recurrence in the rural population in central Pennsylvania.

Real-world outcomes associated with the use of the EmboTrap revascularization device for ischemic stroke in the United States

2021 ◽  
pp. neurintsurg-2021-018175
Author(s):  
Waleed Brinjikji ◽  
Shelly Ikeme ◽  
Emilie Kottenmeier ◽  
Alia Khaled ◽  
Sidharth M ◽  
...  
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Real World ◽  
Hospital Costs ◽  
Standard Of Care ◽  
The United States ◽  
Healthcare Database ◽  
Discharge Status ◽  
Health Organization

BackgroundMechanical thrombectomy (MT) has become the standard of care for the treatment of acute ischemic stroke (AIS). The EmboTrap revascularization device (CERENOVUS, Johnson & Johnson Medical Devices, Irvine, California, USA) has an innovative, dual layer feature designed to facilitate thrombus retrieval.ObjectiveTo investigate the real-world clinical and economic outcomes among patients with AIS undergoing MT using the EmboTrap device in the United States (US).MethodsAdult patients (≥18 years) who underwent MT for AIS using the EmboTrap device between July 2018 and December 2020 were identified from the Premier Healthcare Database. Patient outcomes included discharge status (including in-hospital mortality), mean length of stay (LOS), intracranial hemorrhage (ICH), mean hospital costs, and 30-day readmissions (all-cause, cardiovascular (CV)-related, and AIS-related).ResultsA total of 318 patients (mean age 68.5±14.6 years) with AIS treated with the EmboTrap device as the only stent retriever used were identified. Approximately 25% of patients were discharged to home/home health organization, and the in-hospital mortality rate was 10.7%. The rate of ICH was 16.7%. Mean hospital LOS was 9.9±11.3 days, and the mean hospital costs were US$47 367±30 297. The 30-day readmission rate was 9.6% for all-causes, 5.9% for CV-related causes, and 2.6% for AIS-related causes.ConclusionsThis is the first study in the US to report real-world outcomes sourced by retrospective database analysis among patients with AIS undergoing MT using the EmboTrap device. Further research is needed to better understand performance of the EmboTrap device in real-world settings.

Abstract 2311: Hospitalization Costs of Stroke among Adults 18-64 Years in the United States

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Guijing Wang ◽  
Zefeng Zhang ◽  
Carma Ayala ◽  
Diane Dunet ◽  
Jing Fang ◽  
...  
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Late Effects ◽  
Average Cost ◽  
Hemorrhagic Stroke ◽  
The United States ◽  
Primary Diagnosis ◽  
Secondary Diagnosis ◽  
Hospitalization Costs ◽  
The Impact

Background and purpose: The average cost of stroke, a leading cause of death and serious long-term disability, has been estimated to range from $468 to $146,149 worldwide, and varies 20-fold in the United States. A robust cost estimate is needed for policy makers, public health researchers and practitioners to use as a reference in making resource allocation decisions and assessing cost-effectiveness of intervention programs. This study examined the hospitalization costs of stroke using a large administrative data. Methods: We identified 97,374 hospitalizations with a primary or secondary diagnosis of stroke from pooling 2006-2008 MarketScan inpatient datasets. We investigated the costs by stratifying the hospitalizations by stroke types (hemorrhagic ICD-9 430-432, ischemic ICD-9 433-434, ill-defined ICD-9 436-437, and late-effects ICD-9 438) and diagnosis status (primary and secondary). For hospitalizations with stroke as the primary diagnosis, we identified those with a secondary diagnosis of hypertension, ischemic heart disease (IHD), and diabetes. We used multiple regression models to estimate the impact of stroke types and diagnosis status on the costs controlling age, sex, geographic region, and Charlson Comorbidity Index (CCI). Results: Of the 97,374 hospitalizations (average cost $20,396 ±23,256), the number of hospitalizations with hemorrhagic, ischemic, ill-defined, and late-effects of stroke was 16,331, 62,637, 38,312, and 14,221 with an average cost of $32,035 ±32,046, $18,963 ±21,454, $19,430 ±22,159, and $18,946±19,891, respectively. Over 61% of the hospitalizations listed stroke as a secondary diagnosis only. Regression results showed that the costs increased by at least $962 per CCI unit increase (p<0.001). Hemorrhagic stroke cost $14,499 more than ischemic stroke (p<0.001). For hospitalizations with the primary diagnosis of stroke, those with a secondary diagnosis of IHD had higher costs than those without IHD, especially among those of ischemic stroke ($9835 higher, p<0.001), while hypertension and diabetes as a secondary diagnosis lowered the costs. Hospitalizations with a primary diagnosis of ischemic stroke had $3195 lower cost than those listed as secondary diagnosis, but hospitalizations with a primary diagnosis of hemorrhagic stroke had $8001 higher cost than those listed as a secondary diagnosis. Conclusions: The costs of stroke hospitalizations were high and varied greatly by stroke types, diagnosis status, and comorbidities. Stroke types and their comorbidities should be considered when developing cost-effective strategies for stroke prevention.

Abstract 196: Thrombolytic Treatment using Drip and Ship Treatment Paradigm among Acute Ischemic Stroke Patients in the United States: Outcomes and impact on regional thrombolytic utilization and referral patterns

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Wondwossen G Tekle ◽  
Saqib A Chaudhry ◽  
Habib Qaiser ◽  
Ameer E Hassan ◽  
Gustavo J Rodriguez ◽  
...  
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
The United States ◽  
Thrombolytic Treatment ◽  
Stroke Patients ◽  
Referral Patterns ◽  
Hospital Outcomes ◽  
Treatment Paradigm

Background: While single center and regional estimates of thrombolytic administration using drip and ship treatment paradigm are available, patient outcomes, thrombolytic utilization, cost, and referral patterns has not been assessed in United States. Objective: To provide national estimates of patients treated with thrombolytics using drip and ship paradigm and determine the impact of drip and ship treatment on regional thrombolytic utilization, treatment cost, and referral patterns of acute stroke patients in a large cohort. Methods: We determined the proportion of patients treated with drip and ship paradigm among all acute ischemic stroke patients treated with thrombolytic treatment and obtained comparative in-hospital outcomes from the Nationwide Inpatient Survey (NIS) data files from October 2008 to December 2009. All the in-hospital outcomes were analyzed after adjusting for potential confounders using multivariate analysis. Thrombolytic utilization, hospitalization cost, and patterns of referral related to drip and ship treatment of acute stroke were estimated. Results: Of the 26,814 ischemic stroke patients who received thrombolytic treatment, 5144 (19%) were treated using drip and ship paradigm. Seventy nine percent of all the drip and ship treated patients were referred to urban teaching hospitals for further care, and 7% of them received follow up endovascular treatment at the referral facility. States with higher proportion of patients treated using the drip and ship paradigm had higher rates of thrombolytic utilization (3.1% vs. 2.4%, p<0.001). After adjusting for age, gender, presence of hypertension, diabetes mellitus, renal failure, and hospital teaching status, outcomes of patients treated with drip and ship paradigm was similar to those who received thrombolytic and stayed in the same facility: self care (odds ratio [OR], 1.055, 95% confidence interval [CI], 0.910-1.224, p=0.4779); death(OR , 0.821 95% CI, 0.619- 1.088, p=0.1688); and nursing home discharge (OR, 1.023, 95% CI, 0.880- 1.189, p=0.7659) at discharge. Drip and ship paradigm was associated with shorter hospital stay (mean [days, SE] 5.9± 0.18 vs. 7.4 ± 0.15, p<0.001), and lower cost of hospitalization (mean total charges [$, SE) 57,000 ± 3,324 vs. 83,000 ± 3,367, p<0.001). Conclusions: One out of every five patients who received thromboytic treatment in United States is currently treated using drip and ship paradigm with comparable adjusted rates of favorable outcomes. There was a higher rates of thrombolytic utilization in States where drip and ship was more commonly implemented.

scholarly journals Impact of COVID-19 on Outcomes in Ischemic Stroke Patients in the United States

2021 ◽  
Vol 30 (2) ◽  
pp. 105535
Author(s):  
Adam de Havenon ◽  
John P. Ney ◽  
Brian Callaghan ◽  
Alen Delic ◽  
Samuel Hohmann ◽  
...  
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
The United States ◽  
Stroke Patients

scholarly journals Evaluating hemoptysis hospitalizations among patients with bronchiectasis in the United States: a population-based cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rachel K. Lim ◽  
Alain Tremblay ◽  
Shengjie Lu ◽  
Ranjani Somayaji
Keyword(s):  
United States ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Bronchial Artery ◽  
Hospital Costs ◽  
The United States ◽  
Hospital Death ◽  
Bronchial Artery Embolization ◽  
Artery Embolization ◽  
Hospitalization Costs

Abstract Background The burden of hospitalizations and mortality for hemoptysis due to bronchiectasis is not well characterized. The primary outcome of our study was to evaluate in-hospital mortality in patients admitted with hemoptysis and bronchiectasis, as well as the rates of bronchial artery embolization, length of stay, and hospitalization costs. Methods The authors queried the Nationwide Inpatient Sample (NIS) claims database for hospitalizations between 2016 and 2017 using the ICD-10-CM codes for hemoptysis and bronchiectasis in the United States. Multivariable regression was used to evaluate predictors of in-hospital mortality, embolization, length of stay, and hospital costs. Results There were 8240 hospitalizations (weighted) for hemoptysis in the United States from 2016 to 2017. The overall in-hospital mortality was 4.5%, but higher in males compared to females. Predictors of in-hospital mortality included undergoing three or more procedures, age, and congestive heart failure. Bronchial artery embolization (BAE) was utilized during 2.1% of hospitalizations and was more frequently used in those with nontuberculous mycobacteria and aspergillus infections, but not pseudomonal infections. The mean length of stay was 6 days and the median hospitalization cost per patient was USD $9,610. Having comorbidities and procedures was significantly associated with increased length of stay and costs. Conclusion Hemoptysis is a frequent indication for hospitalization among the bronchiectasis population. In-hospital death occurred in approximately 4.5% of hospitalizations. The effectiveness of BAE in treating and preventing recurrent hemoptysis from bronchiectasis needs to be explored.

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