Higher Procedural Volumes Are Associated with Faster Treatment Times, Better Functional Outcomes, and Lower Mortality in Patients Undergoing Endovascular Treatment for Acute Ischemic Stroke.
Journal
Annals of neurology
ISSN: 1531-8249
Titre abrégé: Ann Neurol
Pays: United States
ID NLM: 7707449
Informations de publication
Date de publication:
20 Sep 2023
20 Sep 2023
Historique:
revised:
22
08
2023
received:
02
06
2023
accepted:
18
09
2023
pubmed:
21
9
2023
medline:
21
9
2023
entrez:
21
9
2023
Statut:
aheadofprint
Résumé
We aimed to characterize the association of hospital procedural volumes with outcomes among acute ischemic stroke (AIS) patients undergoing endovascular therapy (EVT). This was a retrospective, observational cohort study using data prospectively collected from January 1, 2016 to December 31, 2019 in the Get with the Guidelines-Stroke registry. Participants were derived from a cohort of 60,727 AIS patients treated with EVT within 24 hours at 626 hospitals. The primary cohort excluded patients with pretreatment National Institutes of Health Stroke Scale (NIHSS) < 6, onset-to-treatment time > 6 hours, and interhospital transfers. There were 2 secondary cohorts: (1) the EVT metrics cohort excluded patients with missing data on time from door to arterial puncture and (2) the intravenous thrombolysis (IVT) metrics cohort only included patients receiving IVT ≤4.5 hours after onset. The primary cohort (mean ± standard deviation age = 70.7 ± 14.8 years; 51.2% female; median [interquartile range] baseline NIHSS = 18.0 [13-22]; IVT use, 70.2%) comprised 21,209 patients across 595 hospitals. The EVT metrics cohort and IVT metrics cohort comprised 47,262 and 16,889 patients across 408 and 601 hospitals, respectively. Higher procedural volumes were significantly associated with higher odds (expressed as adjusted odds ratio [95% confidence interval] for every 10-case increase in volume) of discharge to home (1.03 [1.02-1.04]), functional independence at discharge (1.02 [1.01-1.04]), and lower rates of in-hospital mortality (0.96 [0.95-0.98]). All secondary measures were also associated with procedural volumes. Among AIS patients primarily presenting to EVT-capable hospitals (excluding those transferred from one facility to another and those suffering in-hospital strokes), EVT at hospitals with higher procedural volumes was associated with faster treatment times, better discharge outcomes, and lower rates of in-hospital mortality. ANN NEUROL 2023.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023 American Neurological Association.
Références
Berkhemer OA, Fransen PS, Beumer D, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015;372:11-20. https://doi.org/10.1056/NEJMoa1411587.
Saver JL, Goyal M, Bonafe A, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 2015;372:2285-2295. https://doi.org/10.1056/NEJMoa1415061.
Goyal M, Demchuk AM, Menon BK, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. Multicenter study randomized controlled trial research support, non-U.S. Gov't. N Engl J Med 2015;372:1019-1030. https://doi.org/10.1056/NEJMoa1414905.
Jovin TG, Chamorro A, Cobo E, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 2015;372:2296-2306. https://doi.org/10.1056/NEJMoa1503780.
Campbell BC, Mitchell PJ, Kleinig TJ, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 2015;372:1009-1018. https://doi.org/10.1056/NEJMoa1414792.
Martins SO, Mont'Alverne F, Rebello LC, et al. Thrombectomy for stroke in the public health care system of Brazil. N Engl J Med 2020;382:2316-2326. https://doi.org/10.1056/NEJMoa2000120.
Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med 2018;378:11-21. https://doi.org/10.1056/NEJMoa1706442.
Albers GW, Marks MP, Kemp S, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med 2018;378:708-718. https://doi.org/10.1056/NEJMoa1713973.
Menon BK, Sajobi TT, Zhang Y, et al. Analysis of workflow and time to treatment on thrombectomy outcome in the endovascular treatment for small core and proximal occlusion ischemic stroke (ESCAPE) randomized, controlled trial. Circulation 2016;133:2279-2286. https://doi.org/10.1161/CIRCULATIONAHA.115.019983.
Goyal M, Jadhav AP, Bonafe A, et al. Analysis of workflow and time to treatment and the effects on outcome in endovascular treatment of acute ischemic stroke: results from the SWIFT PRIME randomized controlled trial. Radiology 2016;279:888-897. https://doi.org/10.1148/radiol.2016160204.
Luft HS, Bunker JP, Enthoven AC. Should operations be regionalized? The empirical relation between surgical volume and mortality. N Engl J Med 1979;301:1364-1369. https://doi.org/10.1056/NEJM197912203012503.
Begg CB, Cramer LD, Hoskins WJ, Brennan MF. Impact of hospital volume on operative mortality for major cancer surgery. JAMA 1998;280:1747-1751. https://doi.org/10.1001/jama.280.20.1747.
Finks JF, Osborne NH, Birkmeyer JD. Trends in hospital volume and operative mortality for high-risk surgery. N Engl J Med 2011;364:2128-2137. https://doi.org/10.1056/NEJMsa1010705.
Harold JG, Bass TA, Bashore TM, et al. ACCF/AHA/SCAI 2013 update of the clinical competence statement on coronary artery interventional procedures: a report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on clinical competence and training (writing committee to revise the 2007 clinical competence statement on cardiac interventional procedures). Circulation 2013;128:436-472. https://doi.org/10.1161/CIR.0b013e318299cd8a.
Leifer D, Fonarow GC, Hellkamp A, et al. Association between hospital volumes and clinical outcomes for patients with nontraumatic subarachnoid hemorrhage. J Am Heart Assoc 2021;10:e018373. https://doi.org/10.1161/JAHA.120.018373.
Kumbhani DJ, Cannon CP, Fonarow GC, et al. Association of hospital primary angioplasty volume in ST-segment elevation myocardial infarction with quality and outcomes. JAMA 2009;302:2207-2213. https://doi.org/10.1001/jama.2009.1715.
Gaieski DF, Edwards JM, Kallan MJ, et al. The relationship between hospital volume and mortality in severe sepsis. Am J Respir Crit Care Med 2014;190:665-674. https://doi.org/10.1164/rccm.201402-0289OC.
Gupta R, Horev A, Nguyen T, et al. Higher volume endovascular stroke centers have faster times to treatment, higher reperfusion rates and higher rates of good clinical outcomes. J Neurointerv Surg 2013;5:294-297. https://doi.org/10.1136/neurintsurg-2011-010245.
Rinaldo L, Brinjikji W, Rabinstein AA. Transfer to high-volume centers associated with reduced mortality after endovascular treatment of acute stroke. Stroke 2017;48:1316-1321. https://doi.org/10.1161/STROKEAHA.116.016360.
Shim DH, Kim Y, Roh J, et al. Hospital volume threshold associated with higher survival after endovascular recanalization therapy for acute ischemic stroke. J Stroke 2020;22:141-149. https://doi.org/10.5853/jos.2019.00955.
Kim BM, Baek JH, Heo JH, et al. Effect of cumulative case volume on procedural and clinical outcomes in endovascular thrombectomy. Stroke 2019;50:1178-1183. https://doi.org/10.1161/STROKEAHA.119.024986.
Nogueira RG, Haussen DC, Castonguay A, et al. Site experience and outcomes in the Trevo acute ischemic stroke (TRACK) multicenter registry. Stroke 2019;50:2455-2460. https://doi.org/10.1161/STROKEAHA.118.024639.
Saber H, Navi BB, Grotta JC, et al. Real-world treatment trends in endovascular stroke therapy. Stroke 2019;50:683-689. https://doi.org/10.1161/STROKEAHA.118.023967.
Stein LK, Mocco J, Fifi J, et al. Correlations between physician and hospital stroke thrombectomy volumes and outcomes: a nationwide analysis. Stroke 2021;52:2858-2865. https://doi.org/10.1161/STROKEAHA.120.033312.
Waqas M, Tutino VM, Cappuzzo JM, et al. Stroke thrombectomy volume, rather than stroke center accreditation status of hospitals, is associated with mortality and discharge disposition. J Neurointerv Surg 2023;15:209-213. https://doi.org/10.1136/neurintsurg-2021-018079.
Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early Management of Patients with Acute Ischemic Stroke: 2019 update to the 2018 guidelines for the early Management of Acute Ischemic Stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2019;50:e344-e418. https://doi.org/10.1161/STR.0000000000000211.
Adeoye O, Nystrom KV, Yavagal DR, et al. Recommendations for the establishment of stroke Systems of Care: a 2019 update. Stroke 2019;50:e187-e210. https://doi.org/10.1161/STR.0000000000000173.
LaBresh KA, Reeves MJ, Frankel MR, et al. Hospital treatment of patients with ischemic stroke or transient ischemic attack using the “get with the guidelines” program. Arch Intern Med 2008;168:411-417. https://doi.org/10.1001/archinternmed.2007.101.
Schwamm LH, Fonarow GC, Reeves MJ, et al. Get with the guidelines-stroke is associated with sustained improvement in care for patients hospitalized with acute stroke or transient ischemic attack. Circulation 2009;119:107-115. https://doi.org/10.1161/CIRCULATIONAHA.108.783688.
Ormseth CH, Sheth KN, Saver JL, et al. The American Heart Association's get with the guidelines (GWTG)-stroke development and impact on stroke care. Stroke Vasc Neurol 2017;2:94-105. https://doi.org/10.1136/svn-2017-000092.
Xian Y, Fonarow GC, Reeves MJ, et al. Data quality in the American Heart Association get with the guidelines-stroke (GWTG-stroke): results from a national data validation audit. Am Heart J 2012;163:392-398. https://doi.org/10.1016/j.ahj.2011.12.012.
Nogueira RG, Abdalkader M, Qureshi MM, et al. Global impact of COVID-19 on stroke care. Int J Stroke 2021;16:573-584. https://doi.org/10.1177/1747493021991652.
Rao RR, Desai SM, Tonetti DA, et al. Thrombectomy after in-house stroke in the transfer population. J Stroke Cerebrovasc Dis 2020;29:105049. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105049.
Akbik F, Xu H, Xian Y, et al. Trends in reperfusion therapy for In-hospital ischemic stroke in the endovascular therapy era. JAMA Neurol 2020;77:1486-1495. https://doi.org/10.1001/jamaneurol.2020.3362.
Saver JL, Goyal M, van der Lugt A, et al. Time to treatment with endovascular thrombectomy and outcomes from ischemic stroke: a meta-analysis. JAMA 2016;316:1279-1288. https://doi.org/10.1001/jama.2016.13647.
Froehler MT, Saver JL, Zaidat OO, et al. Interhospital transfer before thrombectomy is associated with delayed treatment and worse outcome in the STRATIS registry (systematic evaluation of patients treated with Neurothrombectomy devices for acute ischemic stroke). Circulation 2017;136:2311-2321. https://doi.org/10.1161/CIRCULATIONAHA.117.028920.
Shah S, Xian Y, Sheng S, et al. Use, temporal trends, and outcomes of endovascular therapy after Interhospital transfer in the United States. Circulation 2019;139:1568-1577. https://doi.org/10.1161/CIRCULATIONAHA.118.036509.
Zaidat OO, Yoo AJ, Khatri P, et al. Force recommendations on angiographic revascularization grading standards for acute ischemic stroke: a consensus statement. Stroke 2013;44:2650-2663. https://doi.org/10.1161/STROKEAHA.113.001972.
Smith EE, Saver JL, Cox M, et al. Increase in endovascular therapy in get with the guidelines-stroke after the publication of pivotal trials. Circulation 2017;136:2303-2310. https://doi.org/10.1161/CIRCULATIONAHA.117.031097.
Fanaroff AC, Zakroysky P, Dai D, et al. Outcomes of PCI in relation to procedural characteristics and operator volumes in the United States. J Am Coll Cardiol 2017;69:2913-2924. https://doi.org/10.1016/j.jacc.2017.04.032.
How do stroke units improve patient outcomes? A collaborative systematic review of the randomized trials. Stroke unit trialists collaboration. Stroke 1997;28:2139-2144. https://doi.org/10.1161/01.str.28.11.2139.
Hahn M, Groschel S, Tanyildizi Y, et al. The bigger the better? Center volume dependent effects on procedural and functional outcome in established endovascular stroke centers. Front Neurol 2022;13:828528. https://doi.org/10.3389/fneur.2022.828528.
Kamel H, Parikh NS, Chatterjee A, et al. Access to mechanical thrombectomy for ischemic stroke in the United States. Stroke 2021;52:2554-2561. https://doi.org/10.1161/STROKEAHA.120.033485.
Fonarow GC, Smith EE, Saver JL, et al. Timeliness of tissue-type plasminogen activator therapy in acute ischemic stroke: patient characteristics, hospital factors, and outcomes associated with door-to-needle times within 60 minutes. Circulation 2011;123:750-758. https://doi.org/10.1161/CIRCULATIONAHA.110.974675.
Bray BD, Campbell J, Cloud GC, et al. Bigger, faster? Associations between hospital thrombolysis volume and speed of thrombolysis administration in acute ischemic stroke. Stroke 2013;44:3129-3135. https://doi.org/10.1161/STROKEAHA.113.001981.
Groot AE, van Schaik IN, Visser MC, et al. Association between i.v. thrombolysis volume and door-to-needle times in acute ischemic stroke. J Neurol Apr 2016;263:807-813. https://doi.org/10.1007/s00415-016-8076-5.
Cai Q, Zhu Y, Huang X, et al. Learning curve for endovascular treatment of anterior circulation large vessel occlusion at a single center. Front Neurol 2020;11:587409. https://doi.org/10.3389/fneur.2020.587409.
Ovbiagele B, Saver JL. Day-90 acute ischemic stroke outcomes can be derived from early functional activity level. Cerebrovasc Dis 2010;29:50-56. https://doi.org/10.1159/000255974.