Comparing Academic and Non-academic Hospitals in Stroke Care and Mechanical Thrombectomy Outcomes: A Nationwide Propensity Score-matched Analysis
Georgios Sioutas1, Dennis Rivet1, Shraddha Mainali1
1Virginia Commonwealth University
Objective:
To compare ischemic stroke outcomes between academic and non-academic hospitals, with focus on mechanical thrombectomy (MT).
Background:
Hospital type may influence stroke care due to differences in expertise and resources. Academic centers often manage complex cases, but comparative outcomes remain unclear.
Design/Methods:

This retrospective cohort study analyzed electronic health records from the TriNetX Research Network, accessed in June 2025. Adult ischemic stroke patients (≥18 years, ICD-10: I63) with documented NIHSS scores (ICD-10: R29.7) between 2015 and 2025 were included. Patients were categorized by healthcare facility type (academic vs. non-academic). Propensity score matching (PSM) adjusted for demographics, comorbidities, NIHSS scores, social determinants of health, and medication use. Outcomes were assessed up to 90 days post-stroke.

Results:

Of 227,246 patients, 65.1% were treated at academic centers. Academic centers had higher proportions of younger, White, and Black patients. Academic centers also treated patients with more severe strokes. After matching (n=56,590 per group), academic centers demonstrated significantly higher rates of mortality (11.2% vs. 7.1%), MT (9.5% vs. 7.3%), ICH (13.4% vs. 9.8%), IV thrombolysis at different facilities (9.1% vs. 5.7%), readmissions (33.2% vs. 31.3%), ICU utilization (42.4% vs. 34.8%), and withdrawal of life supporting therapy (21.5% vs. 19.3%; all p<0.001). Conversely, academic centers had lower rates of IV thrombolysis (9.0% vs. 11.6%, p<0.001) and dependent functional status at discharge (13.8% vs. 14.5%, p<0.001), andemergency department (ED) utilization (9.1% vs. 9.7%, p=0.001). Subgroup analyses showed broadly consistent trends, with some variation in ICH, ED utilization, readmissions, and functional status showed some variation.

Conclusions:
Academic centers manage more severe cases and perform advanced interventions, such as MT, and fewer IV thrombolysis, with higher complication and mortality rates. These findings emphasize the need for tailored care pathways, resource optimization, and targeted strategies to address the unique challenges of each facility type, ultimately aiming to improve outcomes for all stroke patients.
10.1212/WNL.0000000000217550
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.