Fawaz Al-Mufti (United States of America)
New York Medical College Neurocritical CareAuthor Of 2 Presentations
OBSTRUCTIVE SLEEP APNEA CONFERS LOWER MORTALITY RISK IN ACUTE ISCHEMIC STROKE PATIENTS TREATED WITH ENDOVASCULAR THROMBECTOMY: NATIONAL INPATIENT SAMPLE ANALYSIS 2010-2018
- Justin Lapow (United States of America)
Abstract
Background and Aims:
Obstructive Sleep Apnea (OSA) has previously been shown to portend increased morbidity and mortality following acute ischemic stroke (AIS). Evaluation of OSA in the setting of AIS treated with endovascular mechanical thrombectomy (MT) has not yet been evaluated in the literature.
Methods:
The National Inpatient Sample was queried from 2010-2018 to identify adult AIS patients treated with MT. Those with and without OSA were compared on the basis of clinical characteristics, complications, and discharge disposition. Multivariable logistic regression analysis was employed to evaluate independent associations between OSA and clinical outcome.
Results:
Among 101,093 AIS patients treated with MT identified in our analysis, 6,412 (6.3%) had OSA. The OSA group had significantly higher rates of obesity (41.4% vs. 10.5%, p < 0.001), atrial fibrillation (47.1% vs. 42.2%, p = 0.001), hypertension (87.4% vs. 78.5%, p < 0.001), and diabetes mellitus (41.2% vs. 26.9%, p < 0.001). OSA patients treated with MT demonstrated lower rates of intracranial hemorrhage (19.1% vs. 21.8%, p = 0.017), treatment of hydrocephalus (0.3% vs. 1.1%, p = 0.009), and in-hospital mortality compared to non-OSA patients (9.7% vs. 13.5%, p < 0.001). In a multivariable logistic regression model controlling for age, acute illness and stroke severity, and comorbid conditions, OSA status was independently associated with in-hospital mortality (OR = 0.78, 95% CI = 0.63-0.96, p = 0.020).
Conclusions:
OSA was found to be independently associated with in-hospital mortality after treatment of AIS with MT. Our findings suggest MT is a viable and safe treatment option for AIS patients with OSA.
MANAGEMENT OF ACUTE ISCHEMIC STROKES IN PATIENTS WITH DEVELOPMENTAL DISORDERS THE NATIONAL INPATIENT SAMPLE
- Aiden Lui
Abstract
Background and Aims:
A large publicly-available nationwide hospital database was analyzed to explore the impact of acute ischemic stroke (AIS) and its treatment on mortality and discharge dispositions in patients with developmental disorders.
Methods:
This retrospective cohort study was conducted using data from the National Inpatient Sample (NIS). This publicly available NIS database represents a 20% stratified sample of all discharges, and is powered to estimate 95% of all inpatient care delivered across hospitals in the United States. A total of 887,359 patients were hospitalized between 2012-2017 with an admission diagnosis of AIS. 559 of these patients had pre-existing developmental disorders.
Results:
Patients with developmental disorders admitted to hospitals for AIS were younger (p < .001) and received higher acute illness severity (p = .001) scores along with higher stroke severity (p = .042) scores upon admission. These patients were observed to have lower rates of medical management (2.5% versus 5.4%; p = .002) despite their longer hospital stay (p < .001) compared to fully-abled patients. Upon discharge, patients with developmental disorders were found to have higher all-cause in-hospital mortality rates (p < .001) and poorer discharge disposition (p < .001). Following propensity score-matching on the basis of age, illness severity, stroke severity, and disability status, rates of medical management were the only statistically significant (p < .001) variable in improving functional outcomes.
Conclusions:
The decrease in rates of medical management of AIS in patients with developmental disorders compared to fully-abled patients is significantly correlated to the poorer discharge dispositions observed in these populations.