Neighborhood Socioeconomic Status and Mechanical Thrombectomy Outcomes

Salwi, Sanjana; Kelly, Katherine A.; Patel, Pious D.; Fusco, Matthew R.; Mistry, Eva; Mistry, Akshitkumar M.; Chitale, Rohan

doi:10.1016/j.jstrokecerebrovasdis.2020.105488

Cited by 15 publications

(23 citation statements)

References 39 publications

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“…Although it is unclear whether these income and insurance disparities contributed to the worse outcomes in women, similar results have been published by studies focusing on medical treatment of VTE, thrombectomy in ischemic stroke, and myocardial infarction. 14,[43][44][45] Potential explanations include delays in hospital presentation resulting from geographical locations with decreased access to hospitals, differences in use of standard practice, health care delivery systems, and performance of emergency services. Additionally lower literacy levels contributing to lag in self recognition of symptoms leading to a more complicated presentation.…”

Section: Discussionmentioning

confidence: 99%

Sex Differences in Outcomes of Percutaneous Pulmonary Artery Thrombectomy in Patients With Pulmonary Embolism

Agarwal

Dhaliwal

Yang

et al. 2023

Chest

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Section: Discussionmentioning

confidence: 99%

Sex Differences in Outcomes of Percutaneous Pulmonary Artery Thrombectomy in Patients With Pulmonary Embolism

Agarwal

Dhaliwal

Yang

et al. 2023

Chest

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“…21,22 In addition, a recent evaluation indicated that low socioeconomic status was an unadjusted risk factor for worse 90-day MT outcomes (mRS 3 to 6). 23 University of Florida Health Jacksonville has a unique role as a comprehensive certified stroke center serving a predominantly disadvantaged population, as witnessed by the area of deprivation index of our study population (Table 2). The area of deprivation index was developed by Singh and Siahpush 37 and updated by Kind et al 38 and Hu et al 39 It combines 17 measures of income, employment, education, and housing collected in the 2018 American Community Survey and exists as an easy-to-use online map of deprivation based on the aggregate information validated to census block groups/neighborhoods of 1500 people based on address.…”

Section: Discussionmentioning

confidence: 99%

“…Population differences are further emphasized by decreased access to MT based on ethnicity and insurance status 21,22. However, broad generalizations of race are insufficient to describe outcomes since geographic and socioeconomic status may be more important mediators of stroke outcomes 20,23,24…”

mentioning

confidence: 99%

“…21,22 However, broad generalizations of race are insufficient to describe outcomes since geographic and socioeconomic status may be more important mediators of stroke outcomes. 20,23,24 We retrospectively evaluated the impact socioeconomic deprivation 25 and anesthesia care on clinical outcomes of 125 consecutive adult patients with large vessel AIS and extended ischemic times up to 24 hours treated with second generation MT devices at the University of Florida College of Medicine in Jacksonville. This institution is a level one trauma center and comprehensive certified stroke center with a mission to provide health care for all individuals, especially low-income and other vulnerable populations regardless of insurance or financial resources.…”

mentioning

confidence: 99%

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Anesthesia, Blood Pressure, and Socioeconomic Status in Endovascular Thrombectomy for Acute Stroke: A Single Center Retrospective Case Cohort

Hoefnagel¹,

Yao²,

Rao³

et al. 2021

Journal of Neurosurgical Anesthesiology

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Introduction: Mechanical thrombectomy (MT) is standard for acute ischemic stroke (AIS), with early studies suggesting that general anesthesia (GA) is associated with worse outcomes than monitored anesthesia care (MAC). Socioeconomic deprivation is also a risk factor for worse AIS outcomes. With improvements in MT and blood pressure (BP) management, it remains unclear if GA or socioeconomic deprivation are risk factors for worse outcomes after MT.Methods: We retrospectively analyzed 125 consecutive AIS patients presenting for MT at a comprehensive stroke center serving patients with high levels of socioeconomic deprivation. The primary objective was impact of GA versus MAC on functional independence at 90 days. Secondary outcomes included procedural BP, and impact of BP and socioeconomic deprivation (assessed by the area of deprivation index) on outcomes.Results: A 90-day outcomes were similar in patients undergoing MT with GA or MAC. The area of deprivation index was similar in GA and MAC groups and in patients with good versus poor 90-day outcomes. There were similar numbers of patients with mean arterial pressure (MAP) < 60 mm Hg in the MAC and GA groups (8 vs. 11; P = 0.21), but more patients with MAP < 70 mm Hg in the GA group (28 vs. 9; P < 0.001). Median (interquartile range) duration of MAP < 70 mm Hg was 10 (5 to 15) and 20 (10 to 36) minutes in the MAC and GA groups, respectively (P < 0.001); however, these MAPs were not associated with worse 90-day outcomes.Conclusion: Anesthesia and MAP did not affect MT outcomes. The cohort is unique based on an area of deprivation index in the higher deciles in the United States. While the area of deprivation index was not associated with worse outcomes, further study is warranted.

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“…A probability of match of >95% based on the calculated longitude and latitude was used as the threshold for an acceptable address to census block pairing. 18 Patient addresses were also used to estimate the distance to the hospital. The Point Distance Analysis tool in ArcMap 10.7.0 was used to identify the minimum distance between the longitude and latitude coordinates of the patient and hospital.…”

Section: Variablesmentioning

confidence: 99%

Loss to Follow-up and Unplanned Readmission After Emergent Surgery for Acute Subdural Hematoma

et al. 2022

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BACKGROUND:Loss to follow-up (LTF) and unplanned readmission are barriers to recovery after acute subdural hematoma evacuation. The variables associated with these postdischarge events are not fully understood.OBJECTIVE:To determine factors associated with LTF and unplanned readmission, emphasizing socioeconomic status (SES).METHODS:A retrospective analysis was conducted of surgical patients with acute subdural hematoma managed operatively from 2009 to 2019 at a level 1 regional trauma center. Area Deprivation Index (ADI), which is a neighborhood-level composite socioeconomic score, was used to measure SES. Higher ADI corresponds to lower SES. To decrease the number of covariates in the model, principal components (PCs) analysis was used. Multivariable logistic regression analyses of PCs were performed for LTF and unplanned readmission.RESULTS:A total of 172 patients were included in this study. Thirty-six patients (21%) were LTF, and 49 (28%) patients were readmitted; 11 (6%) patients were both LTF and readmitted (P = .9). The median time to readmission was 10 days (Q1: 4.5, Q3: 35). In multivariable logistic regression analyses for LTF, increased ADI and distance to hospital through PC2 (odds ratio [OR] 1.49; P = .009) and uninsured/Medicaid status and increased length of stay through PC4 (OR 1.73; P = .015) significantly contributed to the risk of LTF. Unfavorable discharge functional status and nonhome disposition through PC3 were associated with decreased odds of unplanned readmission (OR = 0.69; P = .028).CONCLUSION:Patients at high risk for LTF and unplanned readmissions, as identified in this study, may benefit from targeted resources individualized to their needs to address barrier to follow-up and to ensure continuity of care.

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Neighborhood Socioeconomic Status and Mechanical Thrombectomy Outcomes

Cited by 15 publications

References 39 publications

Sex Differences in Outcomes of Percutaneous Pulmonary Artery Thrombectomy in Patients With Pulmonary Embolism

Sex Differences in Outcomes of Percutaneous Pulmonary Artery Thrombectomy in Patients With Pulmonary Embolism

Anesthesia, Blood Pressure, and Socioeconomic Status in Endovascular Thrombectomy for Acute Stroke: A Single Center Retrospective Case Cohort

Loss to Follow-up and Unplanned Readmission After Emergent Surgery for Acute Subdural Hematoma

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