Abstract Body: Background: Decompressive hemicraniectomy (DHC) and mechanical thrombectomy (MT) are critical interventions for acute ischemic stroke. This study examined trends in their use from 2016 to 2021, the relationship between them, and associated patient demographics and outcomes.
Methods: National inpatient Sample (NIS) (n=798,712) was analyzed. Trends in DHC and MT per year were analyzed using the Cochran-Armitage test for trend to assess changes in DHC use over time and assessed overall and stratified by MT status. Logistic regression evaluated the association between year, MT, and their interaction with DHC odds. Patient demographics and outcomes were also examined.
Results Overall, DHC use increased significantly from 2016 to 2021 with a non-linear trend (chi2(4)=86.69, p<0.0001), indicating a notable increase in DHC utilization between 2016 and 2021. The test for departure from trend was also significant (chi2(4)=86.69, p<0.0001), MT was associated with higher DHC likelihood (OR 4.43, p<0.001). The interaction between MT and year was insignificant, indicating a consistent effect of MT on DHC over time. MT use also increased significantly (ORs 1.27-2.43, all p<0.0001). In MT patients, DHC odds increased (ORs 1.69-2.24, p<0.013). In non-MT patients, DHC odds also increased (ORs 1.82-2.04, all p<0.0001). The MT with DC group had a higher proportion of females (43.61% vs 42.59%) and African Americans (25.04% vs 19.75%). %). The overall in-hospital mortality rate was 6.96%.
Conclusions: Both DHC and MT use are increasing in stroke patients. These findings underscore the evolving landscape of acute stroke care, with an increasing emphasis on aggressive and comprehensive management.