Effect of Time from Puncture to Recanalization on Poststroke Disposition and Associated Costs

Abstract

Background: This study investigates the relationship between procedure time during stroke thrombectomy and acute posthospital disposition, as well as the associated costs. Despite extensive literature focusing on long-term outcomes, immediate posthospital patient disposition and its economic impact remain underexplored. Methods: This retrospective study analyzed 721 patients undergoing thrombectomy at a single neuroendovascular practice from 2011 to 2020. Key metrics included disposition and time from groin puncture to recanalization (PTR). Patient dispositions were categorized into 4 groups: acute/subacute rehabilitation, home/home with physical therapy (PT), death/hospice, and long-term care. Multinomial logistic regression, adjusted for age, National Institutes of Health Stroke Scale score, and comorbidities, was used to model predicted disposition probabilities over a range of PTR times. Disposition-based direct acute care costs were applied to estimate the cost impact of PTR delays. Results: PTR was significantly associated with disposition (P = 0.003). In adjusted multinomial regression, each 15-minute PTR increase was associated with higher odds of death/hospice (odds ratio [OR]: 1.020, 95% CI: [1.008-1.032], P = 0.001) and no significant change in acute/subacute rehab (OR: 1.007, 95% CI: [0.997-1.017], P = 0.152) and long-term care (OR: 1.007, 95% CI: [0.990-1.025], P = 0.432) relative to home/home with PT. Additionally, every 15-minute delay was associated with a 2-4.6 percentage point increase in the likelihood of death/hospice, and a 1.5-2.5 percentage point decrease in the likelihood of home/home with PT. A cost analysis suggested that each 15-minute delay in PTR resulted in an approximate $190 (95% CI: [$184-$196], P<0.001) increase in direct acute care costs per stroke episode. Conclusion: Longer PTR is associated with increased death/hospice dispositions and measurable cost increases. Extrapolating nationally, every 15-minute PTR delay results in a $7.2-$7.7 million annual increase in stroke-related health care costs.