title: Hospital transfer associated with increased mortality after endovascular revascularization for acute ischemic stroke.
abstract: BACKGROUND
  Patients with an acute ischemic stroke (AIS) due to large vessel occlusion often require transfer to an endovascular center for treatment.
  
  
  OBJECTIVE
  To assess the effect of hospital transfer on outcomes after endovascular revascularization.
  
  
  METHODS
  Outcomes of endovascular revascularization were compared between directly admitted and transferred patients using data from a national database and our own institution.
  
  
  RESULTS
  118 institutions within the database reported outcomes of 8533 inpatient admissions for endovascular treatment of AIS. Mortality rate (14.9% vs 18.6%; p=0.049) and mortality index (1.1 vs 1.6; p=0.048) were significantly lower among directly admitted patients than among transferred patients. Within our institutional cohort of 140 patients who underwent endovascular therapy, directly admitted patients had a significantly faster time to revascularization than transferred patients (277.4 vs 420.4 min; p≤0.0001). Among transferred patients, an increasing distance of transferred hospital to our home institution was associated with an increasing risk of mortality (unit OR=1.26, 95% CI 1.07 to 1.54; p=0.0061).
  
  
  CONCLUSIONS
  Outcomes of revascularization may improve with methods to identify patients with large vessel occlusion before hospital admission, thus increasing the likelihood of initial triage to a comprehensive stroke center for patients eligible for endovascular intervention.
authors.affiliation: Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Lorenzo
authors.identifier: http://orcid.org/0000-0002-7800-7726
authors.initials: L
authors.lastname: Rinaldo
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Waleed
authors.initials: W
authors.lastname: Brinjikji
authors.affiliation: Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Brandon A
authors.initials: BA
authors.lastname: McCutcheon
authors.affiliation: Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Bydon
authors.affiliation: Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.|Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.|Department of Neuroradiology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Harry
authors.initials: H
authors.lastname: Cloft
authors.affiliation: Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.|Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.|Department of Neuroradiology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: David F
authors.initials: DF
authors.lastname: Kallmes
authors.affiliation: Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.|Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Alejandro A
authors.initials: AA
authors.lastname: Rabinstein
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000401:mortality* / Q000601:surgery*; D015331:Cohort Studies; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality* / Q000639:trends; D005260:Female; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008875:Middle Aged; D010360:Patient Transfer / Q000639:trends; D020521:Stroke / Q000401:mortality* / Q000601:surgery*; D017131:Thrombectomy; D016896:Treatment Outcome; D014218:Triage / Q000639:trends
keywords: Embolic; Intervention; Stroke