J Stroke.
2020 Jan;22(1):141-149. 10.5853/jos.2019.00955.
Hospital Volume Threshold Associated with Higher Survival after Endovascular Recanalization Therapy for Acute Ischemic Stroke
- Affiliations
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- 1Department of Neurology, Kyungpook National University Hospital, Daegu, Korea
- 2Department of Neurosurgery, MH Yeonse Hospital, Changwon, Korea
- 3Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
- 4Department of Neurology, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
- 5Department of Neurology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
- 6Department of Neurology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
- 7Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
- 8Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul, Korea
- KMID: 2500926
- DOI: http://doi.org/10.5853/jos.2019.00955
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.
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