Abstract 71: Inpatient Complications, Outcomes and Predictors of Mortality in 80 Years or Older Patients Undergoing Mechanical Embolectomy for Acute Ischemic Stroke
Background and Purpose: Though utilization of mechanical embolectomy has increased in recent years, the procedure is still associated with significant morbidity and mortality in all age groups. We aimed to compare complications and outcomes after mechanical embolectomy between age groups ≥80 years and <80 years and to identify the predictors of mortality among ≥80 years.
Methods: We identified patients with acute ischemic stroke who underwent mechanical embolectomy in 2006-2009 from Nationwide Inpatient Sample (NIS) of Healthcare Cost and Utilization Project (HCUP). We compared co-morbidities and inpatient complications between age ≥80 and <80 years after sample weighting to get estimates of population. Multivariate logistic regression model was constructed to identify predictors of inpatient mortality in age ≥80 years.
Results: Of the 6723 adults who underwent mechanical embolectomy, 1298 (19%) were ≥80 years. Compared to younger, octogenerians were more likely (p<0.05) to be of female gender (68% vs. 46%) and white race (83% vs. 74%). They also had higher Elixhauser co-morbidity index (mean ± SD: 3.4 ± 1.6 vs. 3.0 ± 1.7). Unadjusted mortality rate was higher (31% vs. 22%) and rate of functional independence at discharge was lower (4% vs. 16%) for age ≥80 years. Age ≥80 years had significantly higher incidence of acute myocardial infarction (7% vs. 5%), acute kidney injury (9% vs. 6%), GI bleeding (3% vs. 2%), need for blood products transfusion (10% vs. 8%), and urinary infections (22% vs. 15%). Use of concomitant thrombolytic treatment (intravenous or intra-arterial) was higher (58% vs. 53%) in age ≥80 years. Incidence of intracranial hemorrhage (11% vs. 10%) was similar (p>0.05) between the two cohorts, as were the rates of mechanical ventilation (29% vs. 30%), gastrostomy tube placement (17% vs. 15%) and permanent tracheostomy (0.8% vs. 0.7%). After adjusting for gender, race, inter-facility transfer status, and length of hospitalization, significant predictors of in-hospital mortality for age ≥80 years were intracranial hemorrhage, sepsis, mechanical ventilation, acute myocardial infarction, acute kidney injury, and chronic pulmonary disease. Use of thrombolytic treatment did not change inpatient mortality (Table).
Conclusions: Morbidity and mortality in mechanical embolectomy for ischemic stroke in age ≥80 years are significantly higher compared with younger. Inpatient medical complications independently predict mortality in age ≥80 years.
- © 2012 by American Heart Association, Inc.