The hidden cost of being uninsured: Stroke mortality after mechanical thrombectomy

Le résumé fourni par la source

INTRODUCTION: The impact of insurance status on mortality and functional outcomes has yet to be examined in Mechanical Thrombectomy (MT) patients, despite research on socioeconomic status. OBJECTIVE: Herein we describe the effects of insurance status on MT outcomes while controlling for other components of socioeconomic status like race, gender, and area deprivation index (ADI). METHODS: We performed a retrospective cohort study of 395 patients undergoing MT at a single comprehensive stroke center between 2018 and 2022. Patients were grouped based on presence of insurance on admission. Univariate and multivariate analysis were conducted examining the following outcome variables: length of stay (LoS), readmission within 90 days, good functional outcomes measured as a modified Rankin score at 90 days<3, and death. RESULTS: A total of 44/395 (11.1 %) patients were uninsured. Uninsured patients were significantly younger on average (59.5 ± 18.2 years compared to 67.1 ± 14.7 years (p = 0.010)) On multivariate analysis, insured status was associated with improved mortality rates (OR: 0.33; 95 % CI: 0.11-0.93; p = 0.035). On univariate analysis, insured status did not have a significant effect on favorable functional outcome (OR:1.15; 95 % CI:0.56-2.34; p = 0.70), LoS (OR:1.23; 95 % CI:0.66-2.32; p = 0.511) or readmission rate (OR:1.66; 95 % CI:0.38-7.31; p = 0.50). Discharge disposition neared significance, with 50 % of insured patients being discharged to a rehabilitation facility, while only 29.3 % of uninsured patients were discharged similarly (p = 0.06). CONCLUSION: Lack of insurance is associated with increased mortality following MT after controlling for other socioeconomic variables and may be an important marker of outcomes in AIS patients.

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