Introduction COVID-19 has had innumerable impacts on the healthcare system. Not only has it worsened the degree of patient illness, but it has raised barriers to effective and efficient care (such as resource scarcity and strict patient triaging). COVID-19 has also been closely tied to increased rates of ischemic stroke, particularly among young patients. This, in turn, has led to an increase in disease acuity in an already strained healthcare system. In this study, a national database is used to assess the effect of COVID-19 on thrombectomy rates, mortality, and discharge disposition among stroke patients.

Methods Patients were identified from the National Inpatient Sample (NIS, 2020), a national database which contains information on approximately 7 million annual hospitalizations. Inclusion criteria selected for adult patients with ischemic stroke; those with venous thrombosis or unspecified cerebral infarction were excluded. Patients were stratified by presence or absence of COVID-19 diagnosis. Outcome variables included mechanical thrombectomy, in-hospital mortality, and discharge disposition (which was separated into ‘favorable’ and ‘unfavorable’ discharges). Additional patient demographics, hospital characteristics, and disease severity metrics were collected. Disease severity was assessed with (1) APR-DRG risk of mortality/disease severity and (2) Elixhauser Comorbidity Index. Statistical analysis was performed via multivariable logistic regression and log-binary regression.

Results 54,368 patients were included in the study; 2116 (3.89%) were diagnosed with COVID-19. In general, patients with COVID-19 were more likely to be male (57.4% vs. 51.5%), be younger in age, and present with increased disease severity.

After controlling for patient demographics, hospital characteristics, and disease severity, COVID-19 was associated with significantly lower rates of mechanical thrombectomy (OR 0.94, p<0.0001). COVID-19 was also associated with higher rates of in-hospital mortality (OR 1.14, p<0.0001) and unfavorable discharge disposition (OR 1.08, p<0.0001), even when controlling for APR-DRG illness severity and Elixhauser Comorbidity Index. Other significant relationships were also identified; for example, thrombectomy was less common at small hospitals (OR 0.94, p<0.0001) or medium hospitals (OR 0.96, p<0.0001).

Conclusion This study identified a relationship between COVID-19 diagnosis and worse outcomes for each metric assessed. Most notably, even when controlling for disease-related factors, patients with COVID-19 were significantly less likely to undergo mechanical thrombectomy. Further, COVID-19 was associated with increased in-hospital mortality and worsened discharge disposition, although the exact causal relationship of this is unclear. Several factors might underly this, ranging from systemic/multisystem inflammation and worsened disease severity to logistical barriers to treatment caused by COVID-19. Further research is needed to determine causality of these findings.

Disclosures J. Dallas: None. K. Liu: None. T. Wenger: None. M. Lin: None. L. Ding: None. F. Attenello: None. W. Mack: None.