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Utilization of long-term care after decompressive hemicraniectomy for severe stroke among older patients

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Abstract

Background

While clinical trial data support decompressive hemicraniectomy (DHC) as improving survival among patients with severe ischemic stroke, quality of life outcomes among older persons remain controversial.

Aims

To aid decision-making and understand practice variation, we measured long-term outcomes and patterns of regional variation for a nationwide cohort of ischemic stroke patients after DHC.

Methods

Medicare fee-for-service ischemic stroke cases over age 65 during the year 2008 were used to create a cohort followed for 2 years (2009–2010) after stroke and DHC procedure. Rates of mortality, acute hospital readmission, and long-term care (LTC) utilization were calculated. Multiple logistic regression was used to identify individual predictors of institutional LTC. Regional variation in DHC was calculated through aggregation and merging with the state-level data.

Results

Among 397,503 acute ischemic stroke patients, 130 (0.03 %) underwent DHC. Mean age was 72 years, and 75 % were between the ages of 65 and 74. Mortality was highest (38 %) within the first 30 days. At 2 years, 59 % of the original cohort had died. The 30-day rate of acute hospital readmission was 25 %. Among survivors, 75 % returned home 1 year after index stroke admission. States with higher per capita health expenditures were associated with wider variation in utilization of DHC.

Conclusions

There is a high rate of mortality among older stroke patients undergoing DHC. Although most survivors of DHC are not permanently institutionalized, there is wide variation in utilization of DHC across the USA.

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Acknowledgments

The authors would like to thank Jim Lucht, MCP, for his help with manuscript preparation.

Funding

Funding for this study was obtained from the Surdna Foundation and the American Academy of Neurology/American Brain Foundation.

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Authors and Affiliations

  1. Division of Neurocritical Care, Brown University Alpert Medical School, Rhode Island Hospital, 593 Eddy St, APC-712.6, Providence, RI, 02903, USA

    Corey R. Fehnel , Linda C. Wendell, Bradford B. Thompson & N. Stevenson Potter

  2. Department of Health Services, Policy and Practice, Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, RI, USA

    Corey R. Fehnel , Yoojin Lee & Vincent Mor

Authors
  1. Corey R. Fehnel
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  2. Yoojin Lee
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  3. Linda C. Wendell
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  4. Bradford B. Thompson
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  5. N. Stevenson Potter
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  6. Vincent Mor
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Corresponding author

Correspondence to Corey R. Fehnel .

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Conflict of interest

Dr. Fehnel receives support from the Surdna Foundation and the American Academy of Neurology/American Brain Foundation. Drs. Wendell, Potter, Thompson, and Ms. Lee report no relevant conflicts of interest. Dr. Mor receives support from AHRQ (2T32 HS000011-28), NIA (2T32 AG023482-08A1), U01 AG032947: a National Study of Disability Trends and Dynamics, the American Health Care Association (AHCA): Development of MDS-based measures of Length of Stay, NIA (R03 AG046482-01). NIA (P01 AG027296-06A1), and the Veteran’s Administration INTERACT in VA Community Living Centers.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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For this type of study formal consent is not required.

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Fehnel , C.R., Lee, Y., Wendell, L.C. et al. Utilization of long-term care after decompressive hemicraniectomy for severe stroke among older patients. Aging Clin Exp Res 29, 631–638 (2017). https://doi.org/10.1007/s40520-016-0615-5

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  • DOI: https://doi.org/10.1007/s40520-016-0615-5

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