TY - JOUR
T1 - Correlations between Physician and Hospital Stroke Thrombectomy Volumes and Outcomes
T2 - A Nationwide Analysis
AU - Stein, Laura K.
AU - Mocco, J.
AU - Fifi, Johanna
AU - Jette, Nathalie
AU - Tuhrim, Stanley
AU - Dhamoon, Mandip S.
N1 - Funding Information:
Dr Fifi reports the following disclosures: consultant: Stryker; grants and personal fees: Microvention; and other: Imperative Care. Dr Jette receives grant funding paid to her institution for grants unrelated to this work from National Institutes of Neurological Disorders and Stroke (NIH U24NS107201 and NIH IU54NS100064), Patient-Centered Outcomes Research Institute and Alberta Health. She receives an honorarium for her work as an Associate Editor of Epilepsia and she sits on the editorial board of Neurology. She is the Bludhorn Professor of International Medicine. Dr Mocco reports the following disclosures: Research Support: Stryker; Research Support: Penumbra Research Support: Medtronic Research Support: Microvention Consultant/Ownership Interest: Imperative Care Consultant/Ownership Interest: Cerebrotech Consultant/Ownership Interest: Viseon Consultant/ Ownership Interest: Endostream Consultant/Ownership Interest: Rebound Therapeutics Consultant/Ownership Interest: Vastrax Investor/Stockholder/Owner: BlinkTBI Investor/Stockholder/Owner: Serenity Investor/Stockholder/Owner: Neurotechnology Investors Investor/Stockholder/Owner: Neurvana Investor/ Stockholder/Owner: Cardinal Consulting. The other authors report no conflicts.
Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.
PY - 2021/9/1
Y1 - 2021/9/1
N2 - Background and Purpose: Despite the Joint Commission's certification requirement of ≥15 stroke thrombectomy (ST) cases per center and proceduralist annually, the relationship between ST case volumes and outcomes is uncertain. We sought to determine whether a proceduralist or hospital volume threshold exists that is associated with better outcomes among Medicare beneficiaries. Methods: Retrospective cohort study using validated International Classification of Diseases, Tenth Revision, Clinical Modification codes to identify admissions with acute ischemic stroke and treatment with ST. We used de-identified, national 100% inpatient Medicare data sets from January 1, 2016, to December 31, 2017 for US individuals aged ≥65 years. We calculated total procedures by proceduralist and hospital. We performed adjusted logistic regression of total cases as a predictor of inpatient mortality, good outcome (defined by dichotomized discharge disposition of inpatient rehabilitation or better), and 30-day readmission. We adjusted for sex, age, Charlson Comorbidity Index, availability of neurocritical care, teaching hospital status, socioeconomic status, 2-year stroke volume, and urban versus rural hospital location. We dichotomized case numbers incrementally to determine a volume threshold for better outcomes. Results: Thirteen thousand three hundred thirty-five patients were treated with ST by 2754 proceduralists at 641 hospitals. For every 10 more proceduralist cases, patients had 4% lower adjusted odds of inpatient mortality (adjusted odds ratio, 0.96 [95% CI, 0.95-0.98], P<0.0001) and 3% greater adjusted odds of good outcome (adjusted odds ratio, 1.03 [95% CI, 1.02-1.04], P<0.0001). For every 10 more hospital cases, patients had 2% lower odds of inpatient mortality (adjusted odds ratio, 0.98 [95% CI, 0.98-0.99], P=0.0003) and 2% greater odds of good outcome (adjusted odds ratio, 1.02 [95% CI, 1.01-1.02], P<0.0001). With increasing volumes, there were higher odds of better outcomes. Conclusions: Nationally, higher proceduralist and hospital ST case volumes were associated with reduced inpatient mortality and better outcome. These data support volume requirements in guidelines for ST training and certification.
AB - Background and Purpose: Despite the Joint Commission's certification requirement of ≥15 stroke thrombectomy (ST) cases per center and proceduralist annually, the relationship between ST case volumes and outcomes is uncertain. We sought to determine whether a proceduralist or hospital volume threshold exists that is associated with better outcomes among Medicare beneficiaries. Methods: Retrospective cohort study using validated International Classification of Diseases, Tenth Revision, Clinical Modification codes to identify admissions with acute ischemic stroke and treatment with ST. We used de-identified, national 100% inpatient Medicare data sets from January 1, 2016, to December 31, 2017 for US individuals aged ≥65 years. We calculated total procedures by proceduralist and hospital. We performed adjusted logistic regression of total cases as a predictor of inpatient mortality, good outcome (defined by dichotomized discharge disposition of inpatient rehabilitation or better), and 30-day readmission. We adjusted for sex, age, Charlson Comorbidity Index, availability of neurocritical care, teaching hospital status, socioeconomic status, 2-year stroke volume, and urban versus rural hospital location. We dichotomized case numbers incrementally to determine a volume threshold for better outcomes. Results: Thirteen thousand three hundred thirty-five patients were treated with ST by 2754 proceduralists at 641 hospitals. For every 10 more proceduralist cases, patients had 4% lower adjusted odds of inpatient mortality (adjusted odds ratio, 0.96 [95% CI, 0.95-0.98], P<0.0001) and 3% greater adjusted odds of good outcome (adjusted odds ratio, 1.03 [95% CI, 1.02-1.04], P<0.0001). For every 10 more hospital cases, patients had 2% lower odds of inpatient mortality (adjusted odds ratio, 0.98 [95% CI, 0.98-0.99], P=0.0003) and 2% greater odds of good outcome (adjusted odds ratio, 1.02 [95% CI, 1.01-1.02], P<0.0001). With increasing volumes, there were higher odds of better outcomes. Conclusions: Nationally, higher proceduralist and hospital ST case volumes were associated with reduced inpatient mortality and better outcome. These data support volume requirements in guidelines for ST training and certification.
KW - certification
KW - inpatients
KW - mortality
KW - stroke
KW - thrombectomy
UR - http://www.scopus.com/inward/record.url?scp=85113738661&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.120.033312
DO - 10.1161/STROKEAHA.120.033312
M3 - Article
C2 - 34092122
AN - SCOPUS:85113738661
SN - 0039-2499
VL - 52
SP - 2858
EP - 2865
JO - Stroke
JF - Stroke
IS - 9
ER -