Stroke thrombectomy volume, rather than stroke center accreditation status of hospitals, is associated with mortality and discharge disposition

Abstract

BackgroundFew studies have explored the association between stroke thrombectomy (ST) volume and hospital accreditation with clinical outcomes.ObjectiveTo assess the association of ST case volume and accreditation status with in-hospital mortality and home discharge disposition using the national Medicare Provider Analysis and Review (MEDPAR) database.MethodsRates of hospital mortality, home discharge disposition, and hospital stay were compared between accredited and non-accredited hospitals using 2017–2018 MEDPAR data. The association of annual ST case volume with mortality and home disposition was determined using Pearson’s correlation. Median rate of mortality and number of ST cases at hospitals within the central quartiles were estimated.ResultsA total of 29 355 cases were performed over 2 years at 847 US centers. Of these, 354 were accredited. There were no significant differences between accredited and non-accredited centers for hospital mortality (14.8% vs 14.5%, p=0.34) and home discharge (12.1% vs 12.0%, p=0.78). A significant positive correlation was observed between thrombectomy volume and home discharge (r=0.88; 95% CI 0.58 to 0.97, p=0.001). A significant negative relationship was found between thrombectomy volume and mortality (r=−0.86; 95% CI −0.97 to −0.49, p=0.002). Within the central quartiles, the median number of ST cases at hospitals with mortality was 24/year, and the median number of ST cases at hospitals with home discharge rate was 23/year.ConclusionA higher volume of ST cases was associated with lower mortality and higher home discharge rate. No significant differences in mortality and discharge disposition were found between accredited and non-accredited hospitals.

Workflow Times and Outcomes in Patients Triaged for a Suspected Severe Stroke

“…The Catalonian stroke system of care during trial enrollment period was centralized in Barcelona metropolitan area, where all thrombectomy‐capable centers were located, with consistent rates of thrombolytic and thrombectomy treatment, little variations in workflow time metrics between centers, 34 and a unique provider of pre‐hospital evaluation (Servei d'Emergències Mèdiques). As compared with other stroke systems of care in the United States, with a wide range of stroke center capabilities according to the Joint Commission, 35 larger variability in time metrics and annually patients volume across centers, 36,37 different locations and travel times between centers, 38 and different EMS providers rendering services in the same areas, direct application of our results should be cautiously considered.…”

Higher Procedural Volumes Are Associated with Faster Treatment Times, Better Functional Outcomes, and Lower Mortality in Patients Undergoing Endovascular Treatment for Acute Ischemic Stroke

“…In cardiology, the difference in PCI outcomes by volume is modest and the trade‐offs continue to be debated 16 . Volumes and years of experience at the operator level do play an important role in EVT for stroke 24,25 . Large‐volume hospitals are more likely to be equipped with dedicated neurocritical units and stroke units, which may independently impact outcomes 41…”

“…16 Volumes and years of experience at the operator level do play an important role in EVT for stroke. 24,25 Large-volume hospitals are more likely to be equipped with dedicated neurocritical units and stroke units, which may independently impact outcomes. 41 Despite the relatively higher complexity of stroke care, the current EVT expectations set forth by the Joint Commission are even lower at only 15 procedures/yr (or 30 over 2 years) at both institutional and operator levels.…”

Access to Mechanical Thrombectomy for Stroke: Center Qualifications, Prehospital Management, and Geographic Disparities

“…For example, a recent study has demonstrated that case volume, rather than accreditation status, is associated with lower mortality and better discharge status. 31 Therefore, the implementation of more TCCs should be strategized, taking into account provider coverage, time of access to the treatment center, and case volume to be served.…”