Abstract TP021: 12 versus 24 h Bed Rest After Acute Ischemic Stroke Thrombectomy: A 14-year Retrospective Cohort Study

Background: A minimum of 24-hour bed rest after mechanical thrombectomy (MT) for acute ischemic stroke (AIS) remains widely practiced, yet its benefit over earlier mobilization is unclear. We hypothesized that shorter bed rest durations would yield similar favorable discharge outcomes, in-hospital complications, and readmission rates compared to 24-hour bed rest in AIS patients treated with MT +/- IV thrombolysis. Methods: Consecutive adult AIS patients treated with MT from January 21, 2010, until December 31, 2024, at a single comprehensive stroke center were included. Standard 24-hour bed rest (the protocol prior to April 8, 2020) was retrospectively compared with the center’s current 12-hour protocol. The primary outcome was favorable discharge location (defined as home, inpatient rehabilitation facility, or acute rehabilitation). Secondary outcome measures included incidence of pneumonia, length of stay, 90-day modified Rankin scale (mRS) scores, and readmission rates. Results: 1173 patients were included (638 ≥12 h, 535 ≥24 h). Mean (s.d.) age was 70.2 (14.7) and 69.2 (14.6) and median (IQR) NIHSS was 14.0 (7-20) and 15.0 (8-21). Mean (s.d.) door to puncture times (minutes) were 106.4 (167.9) and 116.8 (157.5). TICI score ≥2b was achieved in 97.4% and 95.7% of patients (Likelihood Ratio χ 2 p=0.20). Favorable discharge location was similar between groups in unadjusted χ 2 -test of proportions (64.1% vs 65.4%, Likelihood Ratio χ 2 p=0.64) and in multivariable logistic regression analysis (Wald χ 2 p=0.99; adjusted OR=1.00; 95% CI=0.76:1.31). The frequency of good outcomes (mRS=0-2) by 90 days between the groups (37.3% vs. 39.8%, χ 2 p-value =0.65) was similar. Unplanned readmission rates at 30 days (8.9 vs. 6.9%, LR χ 2 p-value=0.43) and 90 days (19.9% vs. 15.1%, LR χ 2 p-value=0.18) were not different. In the ≥12 h group, pneumonia rates were higher (unadjusted: 8.2% vs. 5.1%, LR χ 2 p=0.033; adjusted OR= 1.81 (95% CI= 1.09: 3.01), and median (IQR) length of stay was longer (6.0 days vs. 5.1 days, Wilcoxon p <0.001). Conclusion: After adjustment, ≥12 h bed rest after AIS treated with MT showed no significant difference in favorable discharge location or readmission rates compared with ≥24 h bed rest. Higher pneumonia rates and longer length of stay in the ≥12 h group were observed, likely reflecting unmeasured clinical factors rather than bed rest duration. Randomized trials are needed to clarify the impact of bed rest duration and optimal mobilization strategy.