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Abstract Details

Temporal Trends in Hemicraniectomy Utilization
Cerebrovascular Disease and Interventional Neurology
P4 - Poster Session 4 (5:30 PM-6:30 PM)
4-005
Evaluate current trends in racial, age, and sex specific utilization of decompressive hemicraniectomy (HC) in acute ischemic stroke (AIS) patients in the United States over the last decade.
Clinical trials have supported the utility of decompressive hemicraniectomy in selective management of AIS. Analysis of temporal trends may reveal whether HC utilization has increased in target patient populations and whether disparities in utilization exist.
All adult patients with a diagnosis of AIS were identified from the 2004-2015 Nationwide Inpatient Sample (weighted N=4,792,428) using International Classification of Diseases Ninth revision (ICD-9) codes. Proportion of patients undergoing HC in various age, race, and sex groups were ascertained using ICD-9 procedural codes. Temporal trends were mapped by year. Analysis of utilization by age, sex, and race subgroups was conducted via multivariate logistic regression.
Of all eligible AIS patients from 2004-2015, 0.25% underwent HC (.08 in 2004 to .46 in 2015). Increased utilization over time was seen in both men (.13 to .57) and women (.08 to .54), with women showing comparable odds of utilization to men [OR: 0.95 (95% CI: .87-1.04, p=0.27)]. Similarly, increased utilization trends were seen in all age groups with the highest rates in the 18-39 subgroup (1.41%). Compared to trends in this younger subgroup (.43 to 2.12), patients aged 60-79 experienced a similar overall increase but at lower utilization rates (.06 to .37). Compared to white patients in multivariate models, blacks did not show significant differences in odds of HC [1.09 (.96-1.24, p=0.20)], while patients from Hispanic [1.25 (1.03-1.51, p=0.02)] and other [1.26 (1.04-1.52, p=0.02)] race-ethnic groups showed increased odds.

From 2004-2015, hemicraniectomy rates have seen substantial increases in all age, sex, and race groups. The increasing rates of hemicraniectomies among those aged 60+ suggest that there has been at least partial acceptance of DESTINY 2 study results.
Authors/Disclosures
Sai P. Polineni, MD
PRESENTER 		Dr. Polineni has nothing to disclose.
Fadar O. Otite, MD (SUNY Upstate Medical University) Dr. Otite has nothing to disclose.
Seemant Chaturvedi, MD, FAHA, FÂ鶹´«Ã½Ó³»­ (University of Maryland) Dr. Chaturvedi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bayer. Dr. Chaturvedi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Chaturvedi has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association. The institution of Dr. Chaturvedi has received research support from NINDS.