Lower mortality, higher discharge rates in stroke patients before COVID-19 pandemic
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Patients with large vessel occlusion strokes who underwent mechanical thrombectomy had lower mortality rates and higher rates of routine discharge in 2019 compared with 2020, although mortality rates shifted with surges of COVID-19.
“The COVID-19 pandemic that began in 2020 impacted clinical care by causing delay in care to achieve greater infection control measures,” Robert M. Starke, MD, associate professor of clinical neurosurgery and neuroradiology at University of Miami Miller School of Medicine, and colleagues wrote in a poster presentation at the International Stroke Conference. “In patients with acute ischemic strokes due to large vessel occlusion, rapid intervention is necessary for optimal outcomes.”
Researchers aimed to test the hypothesis patients with large vessel occlusion (LVO) strokes who underwent mechanical thrombectomy at the onset of the pandemic in 2020 had poorer outcomes compared with similar patients in 2019, before the pandemic.
Starke and colleagues used the National Inpatient Sample database to gather nationwide estimates for patients coded for acute ischemic strokes and mechanical thrombectomy in 2019 and 2020. Researchers included 16,225 individuals with LVO in 2019 and 17,100 in 2020.
Results showed that LVO patients in 2019 had a lower mortality rate (9.6% vs. 10.3%) and a higher routine discharge rate (22.1% vs. 20.8%) than patients in 2020.
However, researchers reported that mortality odds were greater in both March and December of 2020 (OR = 1.31 and 1.25, respectively), while odds of routine discharge decreased in March, September and October of 2020 (OR = 0.74, 0.83 and 0.74, respectively) and increased in July and November (OR = 1.26 and 1.17, respectively).
“Overall outcomes for LVO stroke patients undergoing mechanical thrombectomy were not different between 2020 and 2019,” Starke and colleagues wrote. “However, on a month-by-month analysis, patients were more likely to die and less likely to have routine discharge in March, corresponding to the beginning of the COVID-19 pandemic.”
They continued, “Odds of routine discharge were higher in months that occurred on the upswing of national peaks in COVID-19 cases, potentially due the desire to minimize patient volumes in the hospital.”