Impact of Transfer Status on Hospitalization Costs and Discharge Disposition for Patients with Large Vessel Occlusion Stroke
Mihir Khunte1, Huanwen Chen2, Dheeraj Gandhi3, Ajay Malhotra4
1Warren Alpert Medical School of Brown University, 2MedStar Georgetown University Hospital, 3University of Maryland School of Medicine, 4Yale School of Medicine
Objective:

To assess the impact of transferring patients with large vessel occlusion (LVO) strokes to centers for active stroke interventions.

Background:

Many patients with LVO strokes require transfer from an initial facility to a specialized center for interventions such as IVtPA and EVT. Understanding the effects of transfer status is essential for optimizing stroke care pathways.

Design/Methods:

The National Inpatient Sample (2016–2021) was queried to identify patients with a primary diagnosis of cerebral infarction due to internal carotid artery (ICA), middle cerebral artery (MCA), or basilar artery stroke who received active intervention, either EVT or IVtPA. Outcomes such as hospital admission costs, length of stay, and discharge disposition were compared between patients who were directly admitted and those transferred from another facility. Propensity score matching was employed to adjust for potential confounders including demographic characteristics, medical comorbidities, NIH stroke scale, stroke risk factors, and treatment center characteristics.

Results:

A total of 233,265 LVO stroke patients who underwent active intervention with EVT or IVtPA were identified. Among these patients, 22.3% were transferred. Among patients who received tPA, the rate of good discharge (discharge to home without services) was higher among patients who were directly admitted (30.2% vs 17.4%, p-value < 0.001). Similarly, among patients treated with EVT, the rate of good discharge was higher for direct admissions (21.0% vs. 16.5%, p < 0.001). The mean hospitalization cost for IVtPA-treated patients was $34,802 for direct admissions and $32,989 for transferred patients (p = 0.095). For EVT-treated patients, the mean hospitalization cost was $43,318 for direct admissions and $43,830 for transfers (p = 0.394).

Conclusions:

Hospitalization costs for acute stroke interventions were comparable between directly admitted and transferred patients. However, transferred patients had a lower rate of favorable discharge outcomes, which may reflect a longer time from symptom onset to treatment.

10.1212/WNL.0000000000212343
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