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Hospital Volume Threshold Associated with Higher Survival after Endovascular Recanalization Therapy for Acute Ischemic Stroke

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초록

Background and Purpose Endovascular recanalization therapy (ERT) is becoming increasingly important in the management of acute ischemic stroke (AIS). However, the hospital volume threshold for optimal ERT remains unknown. We investigated the relationship between hospital volume of ERT and risk-adjusted patient outcomes. Methods From the National Health Insurance claims data in Korea, 11,745 patients with AIS who underwent ERT from July 2011 to June 2016 in 111 hospitals were selected. We measured the hospital’s ERT volume and patient outcomes, including the 30-day mortality, readmission, and postprocedural intracranial hemorrhage (ICH) rates. For each outcome measure, we constructed risk-adjusted prediction models incorporating demographic variables, the modified Charlson comorbidity index, and the stroke severity index (SSI), and validated them. Risk-adjusted outcomes of AIS cases were compared across hospital quartiles to confirm the volume-outcome relationship (VOR) in ERT. Spline regression was performed to determine the volume threshold. Results The mean AIS volume was 14.8 cases per hospital/year and the unadjusted means of mortality, readmission, and ICH rates were 11.6%, 4.6%, and 8.6%, respectively. The VOR was observed in the risk-adjusted 30-day mortality rate across all quartile groups, and in the ICH rate between the first and fourth quartiles (P<0.05). The volume threshold was 24 cases per year. Conclusions There was an association between hospital volume and outcomes, and the volume threshold in ERT was identified. Policies should be developed to ensure the implementation of the AIS volume threshold for hospitals performing ERT.

Abstract

Background and Purpose Endovascular recanalization therapy (ERT) is becoming increasingly important in the management of acute ischemic stroke (AIS). However, the hospital volume threshold for optimal ERT remains unknown. We investigated the relationship between hospital volume of ERT and risk-adjusted patient outcomes. Methods From the National Health Insurance claims data in Korea, 11,745 patients with AIS who underwent ERT from July 2011 to June 2016 in 111 hospitals were selected. We measured the hospital’s ERT volume and patient outcomes, including the 30-day mortality, readmission, and postprocedural intracranial hemorrhage (ICH) rates. For each outcome measure, we constructed risk-adjusted prediction models incorporating demographic variables, the modified Charlson comorbidity index, and the stroke severity index (SSI), and validated them. Risk-adjusted outcomes of AIS cases were compared across hospital quartiles to confirm the volume-outcome relationship (VOR) in ERT. Spline regression was performed to determine the volume threshold. Results The mean AIS volume was 14.8 cases per hospital/year and the unadjusted means of mortality, readmission, and ICH rates were 11.6%, 4.6%, and 8.6%, respectively. The VOR was observed in the risk-adjusted 30-day mortality rate across all quartile groups, and in the ICH rate between the first and fourth quartiles (P<0.05). The volume threshold was 24 cases per year. Conclusions There was an association between hospital volume and outcomes, and the volume threshold in ERT was identified. Policies should be developed to ensure the implementation of the AIS volume threshold for hospitals performing ERT.

참고문헌 (35)

  1. "GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015", Lancet, 388, pp.1459~1544 (2016)
  2. Berkhemer OA, "A randomized trial of intraarterial treatment for acute ischemic stroke", N Engl J Med, 372, pp.11~20 (2015)
  3. Campbell BC, "Endovascular therapy for ischemic stroke with perfusion-imaging selection", N Engl J Med, 372, pp.1009~1018 (2015)
  4. Goyal M, "Randomized assessment of rapid endovascular treatment of ischemic stroke", N Engl J Med, 372, pp.1019~1030 (2015)
  5. Jovin TG, "Thrombectomy within 8 hours after symptom onset in ischemic stroke", N Engl J Med, 372, pp.2296~2306 (2015)
  6. Saver JL, "Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke", N Engl J Med, 372, pp.2285~2295 (2015)
  7. Bracard S, "Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke(THRACE) : a randomised controlled trial", Lancet Neurol, 15, pp.1138~1147 (2016)
  8. Mocco J, "Aspiration thrombectomy after intravenous alteplase versus intravenous alteplase alone", Stroke, 47, pp.2331~2338 (2016)
  9. Powers WJ, "2018 Guidelines for the early management of patients with acute ischemic stroke : a guideline for healthcare professionals from the American Heart Association", American Stroke Association, 2018, pp.49, e46~e110
  10. Suh SH, "The annual trends between neurointerventional and neurosurgical procedures in Korea : analysis using HIRA data from 2010 to 2016", Neurointervention, 12, pp.77~82 (2017)
  11. Nogueira RG, "Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct", N Engl J Med, 378, pp.11~21 (2018)
  12. Mokin M, "Direct carotid artery puncture access for endovascular treatment of acute ischemic stroke: technical aspects, advantages, and limitations", J Neurointerv Surg, 7, pp.108~113 (2015)
  13. Hirshfeld JW Jr, "Recommendations for the assessment and maintenance of proficiency in coronary interventional procedures : statement of the American College of Cardiology", J Am Coll Cardiol, 31, pp.722~743 (1998)
  14. Christian CK, "The volume-outcome relationship : don’t believe everything you see", World J Surg, 29, pp.1241~1244 (2005)
  15. Luft HS, "The volume-outcome relationship:practice-makes-perfect or selective-referral patterns?", Health Serv Res, 22, pp.157~182 (1987)
  16. Christian CK, "The Leapfrog volume criteria may fall short in identifying high-quality surgical centers", Ann Surg, 238, pp.447~455 (2003)
  17. Fargen KM, "Practice makes perfect : establishing reasonable minimum thrombectomy volume requirements for stroke centers", J Neurointerv Surg, 9, pp.717~719 (2017)
  18. Gupta R, "Higher volume endovascular stroke centers have faster times to treatment, higher reperfusion rates and higher rates of good clinical outcomes", J Neurointerv Surg, 5, pp.294~297 (2013)
  19. "Approved: new thrombectomy-capable stroke center advanced certification program" (2017)[URL]
  20. English JD, "Mechanical thrombectomy-ready comprehensive stroke center requirements and endovascular stroke systems of care : recommendations from the Endovascular Stroke Standards Committee of the Society of Vascular and Interventional Neurology(SVIN)", Interv Neurol, 4, pp.138~150 (2016)
  21. Brinjikji W, "Patient outcomes with endovascular embolectomy therapy for acute ischemic stroke : a study of the national inpatient sample : 2006 to 2008", Stroke, 42, pp.1648~1652 (2011)
  22. Katzan IL, "Risk adjustment of ischemic stroke outcomes for comparing hospital performance : a statement for healthcare professionals from the American Heart Association", American Stroke Association, 2014, pp.45, 918~944
  23. Keenan PS, "An administrative claims measure suitable for profiling hospital performance on the basis of 30-day all-cause readmission rates among patients with heart failure", Circ Cardiovasc Qual Outcomes, 1, pp.29~37 (2008)
  24. English SW, "Subarachnoid hemorrhage admissions retrospectively identified using a prediction model", Neurology, 87, pp.1557~1564 (2016)
  25. Sung SF, "Validity of a stroke severity index for administrative claims data research : a retrospective cohort study", BMC Health Serv Res, 16, pp.509~ (2016)
  26. Lane-Fall MB, "Outcomes measures and risk adjustment", Int Anesthesiol Clin, 51, pp.10~21 (2013)
  27. Goldstein LB, "Charlson Index comorbidity adjustment for ischemic stroke outcome studies", Stroke, 35, pp.1941~1945 (2004)
  28. Zhu HF, "Impact of a stroke unit on length of hospital stay and in-hospital case fatality", Stroke, 40, pp.18~23 (2009)
  29. Saposnik G, "Hospital volume and stroke outcome:does it matter?", Neurology, 69, pp.1142~1151 (2007)
  30. Mesman R, "Why do highvolume hospitals achieve better outcomes? A systematic review about intermediate factors in volume-outcome relationships", Health Policy, 119, pp.1055~1067 (2015)
  31. Lee SY, "The National Health Insurance system as one type of new typology : the case of South Korea and Taiwan", Health Policy, 85, pp.105~113 (2008)
  32. Silber JH, "The hospital compare mortality model and the volume-outcome relationship", Health Serv Res, 45(5 Pt 1), pp.1148~1167 (2010)
  33. Ross JS, "Hospital volume and 30-day mortality for three common medical conditions", N Engl J Med, 362, pp.1110~1118 (2010)
  34. Rinaldo L, "Transfer to high-volume centers associated with reduced mortality after endovascular treatment of acute stroke", Stroke, 48, pp.1316~1321 (2017)
  35. Patel A, "Effect of annual hospital procedure volume on outcomes after mechanical thrombectomy in acute ischemic stroke patients: an analysis of 13,502 procedures (I6.006)", Neurology, 86(Suppl 16), pp.I6.006.~ (2016)

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