Risk Factors and Outcomes in Gastroparesis Following Acute Ischemic Stroke: Analysis of the National Inpatient Sample from 2000-2019

Introduction: Gastrointestinal complications after acute ischemic stroke (AIS) are not well understood. We aimed to investigate the risk factors and outcomes of patients with gastroparesis after AIS over the last 20 years.

Methods: A query of the 2000-2019 National Inpatient Sample was performed for patients admitted with AIS (ICD9 433, 43401, 43411, 43491, ICD-10 I63). Demographics, comorbidities, and outcomes were identified. Univariate analysis with t-tests or chi-square performed as appropriate. A 1:1 nearest neighbor propensity score matched cohort was generated. Variables with standardized mean differences >0.1 used in multivariate regression to generate adjusted odds ratios (AOR)/β-coefficients for gastroparesis on outcomes. Significance set at an alpha level of < 0.001. All analysis performed in R version 4.1.3.

Results: Of 10,415,286 patients with AIS, 35,967 (0.4%) had gastroparesis. These patients had higher Elixhauser Comorbidity Score (11.77 ± 9.24 vs. 9.75 ± 8.82; p< 0.001) and non-significantly higher NIH Stroke Score (6.93 ± 7.20 vs. 6.66 ± 7.30; p>0.001). They were more likely to be female, younger, Black or Hispanic, fourth quartile income, and covered by Medicaid (p < 0.001). They had higher rates of diabetes, hypertension, obesity, acute and chronic kidney disease, seizures, ventilator use, procedural complications, tracheostomy and gastrostomy tube placement (p < 0.001). After propensity matching and multivariate regression, they had prolonged length of stay (1.85 days; 95%CI 1.46-2.23), reduced likelihood of home discharge (AOR 0.8; 95%CI 0.75-0.86), and increased hospital costs ($10327.68; 95%CI 5842.26-14813.09) (p < 0.001).

Conclusion : This propensity-matched 20-year national analysis is the first study to confirm gastroparesis as a notable issue after AIS. These patients have increased risk for procedural interventions, AIS-related complications, longer stay, greater hospital costs, and worse outcomes.