Abstract Details

Title Impact of Residency Training Programs on Outcomes of Acute Ischemic Stroke

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-018

Objective Our study measured outcomes in terms of mortality, inpatient stay (LOS), cost, and intracerebral hemorrhage (ICH) in acute ischemic stroke.

Background Limited evidence is available on the effect of residency training in the management of acute ischemic stroke (AIS).

Design/Methods We used the NIS sample from 2007 to 2014 to identify the diagnosis of ischemic stroke. Hospitals were classified as teaching if they had an American Medical Association approved residency program or a ratio of full-time equivalent interns and residents to beds of 0.25 or higher. Categorical and continuous variables were tested using Chi-square test and Student t-test respectively. The multivariable logistic model was performed for odds of ICH with a significant level of C statistic at >0.7.

Results

We identified total weighted ischemic stroke 3.5M from 2007 to 2014. From them, 1.7M (48.1%) were admitted to teaching and 1.8M (51.9%) to non-teaching hospital. Compared to nonteaching, teaching hospitals administered more tPA 6.34% vs. 3.86% (P value <0.0001), performed more mechanical thrombectomy (MT) 0.76% vs. 0.09% (p <0.0001). However, teaching hospitals also had higher post-tPA ICH 0.51% vs. 0.26 (p <0.0001) and post-MT ICH 0.13% vs. 0.02% (p <0.0001). Mortality rate was 5.12% vs. 4.70% (p=0.0095), cost was $13,713 vs. $10,459 (p <.0001) and LOS was ≈5.6 vs. ≈4.7 days (p <0.0001) at teaching hospitals. After adjusting multivariables, teaching hospitals were found to have a higher odds of ICH with advanced age 1.007 (p <0.0001), tPA use 3.216 (p <0.0001), MT 7.555 (p <0.0001), charlson comorbidity index 1.109 (p <0.0001), alcohol abuse 1.206 (p 0.0001), while history of well-controlled hypertension 0.897 (p <.0001) and female sex 0.856 (p <.0001) reduced the odds of ICH.

Conclusions Negative outcomes were observed in residency programs likely due to the transfer of sicker patients, delaying tPA and MT at smaller centers increasing the risk of ICH.

Authors/Disclosures
Smit D. Patel, MD, MPH PRESENTER	Dr. Patel has nothing to disclose.
Karan K. Topiwala, MBBS (University of Minnesota)	No disclosure on file
Neel Patel, MBBS	No disclosure on file
Tapan Mehta, MD (University of Connecticut, Hartford Hospital)	Dr. Mehta has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Balt, Medtronic, J&J, Terumo.
Gracia C. Mui, MD (UConn Health)	Dr. Mui has nothing to disclose.

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