Impact of Sex on In-Hospital Mortality and Discharge Disposition among Renal Failure Patients Undergoing Mechanical Thrombectomy for Acute Ischemic Stroke

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Abstract
Purpose: Mechanical thrombectomy (MT) has improved outcomes for acute ischemic stroke (AIS); however, patients with renal failure remain at elevated risk for adverse events. Sex-based differences in outcomes following thrombectomy have been reported in heterogeneous stroke populations, but data specific to renal failure patients are limited. Understanding whether sex influences in-hospital mortality and discharge disposition in this high-risk subgroup is clinically important.Materials and Methods: We conducted a retrospective cohort study using the 2019–2022 National Inpatient Sample to identify renal failure patients undergoing MT for AIS. Patients were stratified by sex. Multivariable logistic regression was used to assess associations between sex and in-hospital mortality and non-routine discharge, adjusting for demographic, socioeconomic, clinical, and hospital-level covariates.Results: The study included 3,280 unweighted hospitalizations (1,675 males; 1,605 females). After adjustment, female sex was independently associated with higher odds of non-routine discharge (adjusted odds ratio [OR] 1.536, 95% confidence interval [CI] 1.391–1.696; P<0.001) but not with in-hospital mortality (adjusted OR 0.953, 95% CI 0.874–1.038; P=0.266). Increasing age and select comorbidities were associated with both outcomes.Conclusion: Female sex was associated with increased odds of non-routine discharge but not in-hospital mortality among renal failure patients undergoing MT. These findings support equitable application of thrombectomy across sexes while highlighting the importance of sex-aware discharge planning in this high-risk population.

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