title: Anesthesia Technique and Outcomes of Mechanical Thrombectomy in Patients With Acute Ischemic Stroke.
abstract: The impact of anesthesia technique on the outcomes of mechanical thrombectomy for acute ischemic stroke remains an issue of debate. We investigated the association of general anesthesia with outcomes in patients undergoing mechanical thrombectomy for ischemic stroke.
  
  
  
  We performed a cohort study involving patients undergoing mechanical thrombectomy for ischemic stroke from 2009 to 2013, who were registered in the New York Statewide Planning and Research Cooperative System database. An instrumental variable (hospital rate of general anesthesia) analysis was used to simulate the effects of randomization and investigate the association of anesthesia technique with case-fatality and length of stay.
  
  
  
  Among 1174 patients, 441 (37.6%) underwent general anesthesia and 733 (62.4%) underwent conscious sedation. Using an instrumental variable analysis, we identified that general anesthesia was associated with a 6.4% increased case-fatality (95% confidence interval, 1.9%-11.0%) and 8.4 days longer length of stay (95% confidence interval, 2.9-14.0) in comparison to conscious sedation. This corresponded to 15 patients needing to be treated with conscious sedation to prevent 1 death. Our results were robust in sensitivity analysis with mixed effects regression and propensity score-adjusted regression models.
  
  
  
  Using a comprehensive all-payer cohort of acute ischemic stroke patients undergoing mechanical thrombectomy in New York State, we identified an association of general anesthesia with increased case-fatality and length of stay. These considerations should be taken into account when standardizing acute stroke care.
authors.affiliation: From the Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA (K.B., S.T., P.J.); The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH (K.B., T.A.M.); Neuroscience Institute, Cleveland Clinic/Akron General Hospital, OH (S.M.); and Department of Medicine (T.A.M.) and Department of Community and Family Medicine (T.A.M.), Dartmouth-Hitchcock Medical Center, Lebanon, NH. kbekelis@gmail.com.
authors.forename: Kimon
authors.initials: K
authors.lastname: Bekelis
authors.affiliation: From the Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA (K.B., S.T., P.J.); The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH (K.B., T.A.M.); Neuroscience Institute, Cleveland Clinic/Akron General Hospital, OH (S.M.); and Department of Medicine (T.A.M.) and Department of Community and Family Medicine (T.A.M.), Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors.forename: Symeon
authors.initials: S
authors.lastname: Missios
authors.affiliation: From the Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA (K.B., S.T., P.J.); The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH (K.B., T.A.M.); Neuroscience Institute, Cleveland Clinic/Akron General Hospital, OH (S.M.); and Department of Medicine (T.A.M.) and Department of Community and Family Medicine (T.A.M.), Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors.forename: Todd A
authors.initials: TA
authors.lastname: MacKenzie
authors.affiliation: From the Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA (K.B., S.T., P.J.); The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH (K.B., T.A.M.); Neuroscience Institute, Cleveland Clinic/Akron General Hospital, OH (S.M.); and Department of Medicine (T.A.M.) and Department of Community and Family Medicine (T.A.M.), Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors.forename: Stavropoula
authors.initials: S
authors.lastname: Tjoumakaris
authors.affiliation: From the Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA (K.B., S.T., P.J.); The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH (K.B., T.A.M.); Neuroscience Institute, Cleveland Clinic/Akron General Hospital, OH (S.M.); and Department of Medicine (T.A.M.) and Department of Community and Family Medicine (T.A.M.), Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors.forename: Pascal
authors.initials: P
authors.lastname: Jabbour
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000009:adverse effects / Q000401:mortality* / Q000639:trends; D002545:Brain Ischemia / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D015331:Cohort Studies; D016292:Procedural Sedation / Q000009:adverse effects / Q000379:methods / Q000401:mortality*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D061185:Mechanical Thrombolysis / Q000009:adverse effects / Q000401:mortality* / Q000639:trends; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D020521:Stroke / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D016896:Treatment Outcome
keywords: SPARCS; acute ischemic stroke; general anesthesia; instrumental variable; mechanical thrombectomy