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

Objective We aimed to characterize the association of hospital procedural volumes with outcomes among acute ischemic stroke (AIS) patients undergoing endovascular therapy (EVT). Methods This was a retrospective, observational cohort study using data prospectively collected from January 1, 2016 to De...

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Bibliographic Details
Published in:Annals of neurology 2024-01, Vol.95 (1), p.146-155
Main Authors: Nogueira, Raul G., Haussen, Diogo C., Smith, Eric E., Sun, Jie‐Lena, Xian, Ying, Alhanti, Brooke, Blanco, Rosalia, Mac Grory, Brian, Doheim, Mohamed F., Bhatt, Deepak L., Fonarow, Gregg C., Hassan, Ameer E., Joundi, Raed A., Mocco, J, Frankel, Michael R., Schwamm, Lee H.
Format: Article
Language:English
Subjects:
Cardiovascular system
Hospitals
Ischemia
Missing data
Mortality
Observational studies
Patients
Stroke
Thrombolysis
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Summary:Objective We aimed to characterize the association of hospital procedural volumes with outcomes among acute ischemic stroke (AIS) patients undergoing endovascular therapy (EVT). Methods 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 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. Results 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. Interpretation 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 2024;95:146–155
ISSN:0364-5134
1531-8249
DOI:10.1002/ana.26803