The rate of hemicraniectomy for acute ischemic stroke is increasing in the United States.

Recent randomized trials have shown a significant survival and functional outcome benefit with hemicraniectomy compared with medical therapy for carefully selected patients with acute ischemic stroke (AIS). Using a national hospital database, we sought to determine trends over time in rates of hemicraniectomy after AIS before and after publication of the pooled analysis of hemicraniectomy trials demonstrating the benefit of this approach. We queried the Premier database for all stroke-related admissions (denominator) using Diagnosis-Related Group codes 14, 15, and 524 and International Classification of Disease 9 codes 433, 434, and 436, and for hemicraniectomy (numerator) with Current Procedural Terminology codes 01.2, 01.24, 01.25, and 01.39 for fiscal years 2005-2008. Change over time was tested using negative binomial regression. During the study period, a total of 592,933 admissions for AIS were identified. A procedure code for hemicraniectomy was identified in 426 patients (0.072%). These patients tended to be younger, nonwhite, and male; however, 28% of these patients were over age 65. The rate of hemicraniectomy for AIS increased linearly by 21% per year during the study period (P < .001 for trend). After publication of the pooled analysis in the first quarter of 2007, the rate of hemicraniectomy did not increase further (P = .67 for rates before and after). Our data indicate that the rate of hemicraniectomy in AIS patients in the United States has increased over the past few years, but the total number of procedures remains low. Publication of the landmark study did not appear to significantly change this rate. Future studies should investigate the appropriateness of patient selection and missed opportunities for treatment.