Abstract MP05: Sex Differences In Mortality And 30-day All Cause Readmission Following Carotid Endarterectomy Following Acute Ischemic Stroke: A Nsqip Study (2014 - 2017)

Background: Studies report that acute ischemic stroke (AIS) affects males and females differently. For example, the treatment outcomes of intra-arterial thrombolysis differ between males and females. In this study, we examined mortality and 30-day readmission differences by sex among AIS patients who had carotid endarterectomy (CEA). Methods: We used data from National Surgical Quality Improvement Program (NSQIP) registry (2014-2017). Patients ≥18 years of age, with CEA for AIS were included. AIS and CEA were identified using ICD-9 and ICD-10 diagnosis, and CPT codes, respectively. Using machine learning methods such as Hierarchical clustering, we grouped patients (low, medium, and high-risk clusters) based on their demographics, past medical history, and preoperative variables. Differences in means, and differences in proportions were calculated. Logistic regression was conducted for 30-day readmission and survival analysis for mortality, accounting for cluster groups and sex. Results: There were a total of 22,373 AIS patients who received CEA treatment. Mean (SD) age of the sample was 70.7 (9.4) years, and 61% were males while 39% were females. Mortality rates were 0.8% and 0.7% for men and women (p=0.113), respectively. Thirty-day readmission rates were 6.3% and 7.6% for men and women (p<0.0001), respectively. There were 56.3%, 34.4%, and 9.3% patients in Low, Medium, and High-Risk clusters, respectively. Females were 1.2 times (OR 95% CI: 1.1 - 1.3) as likely to be readmitted compared to males. Survival analysis showed that there was no significant difference in mortality between males and females (HR: 0.8; 95% CI: 0.6 - 1.2; p = 0.28). Conclusion: Our study found sex related disparities in short-term readmissions as it was higher among females. This could be because of underlaying sex specific pathophysiology of AIS. Healthcare providers should consider sex-specific management to improve post-stroke recovery for women and reduce their excess burden.