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O-035 Higher endovascular thrombectomy procedural volume is associated with reduced inpatient mortality
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  1. A Koo1,
  2. D Renedo1,
  3. J Ney2,
  4. A Amllay1,
  5. M Kanzler1,
  6. S Stogniy1,
  7. KW Nowicki1,
  8. A Alawieh3,
  9. N Sujijantarat1,
  10. J Antonios1,
  11. S Al Kasab4,
  12. R Hebert1,
  13. CC Matouk1,
  14. A de Havenon5
  1. 1Department of Neurosurgery, Yale University, New Haven, CT
  2. 2Department of Neurology, Department of Veteran’s Affairs, West Haven, CT
  3. 3Department of Neurosurgery, Emory University, Atlanta, GA
  4. 4Department of Neurology and Neurosurgery, Medical University of South Carolina, Charleston, SC
  5. 5Department of Neurology, Yale Center for Brain and Mind Health, Yale University, New Haven, CT

Abstract

Objective The aim of this study was to determine the impact of thrombectomy procedure volume on in-hospital mortality in ischemic stroke (IS) patients treated with endovascular thrombectomy (EVT).

Methods We performed a retrospective cohort study using the 2020 Florida State Inpatient Database. We included adult patients who had a diagnosis of IS and underwent EVT during the same admission. The primary study outcome was in-hospital death. We used Youden’s Index to define an optimal threshold for number of EVT/year/provider. Based on this cut-point, the cohort was dichotomized into low and high procedural volume EVT providers. We fit logistic regression models to mortality in the full cohort, both as univariate analyses and after adjusting for covariates.

Results Amongst 3,143 IS patients who underwent EVT, 1,907 patients across 59 hospitals and 106 providers met our inclusion criteria. Amongst the 106 providers, the median (interquartile range) number of EVTs performed was 13.5 (7–25). The optimal cut-point was 17 thrombectomy procedures. Demographics and comorbidities were overall similar between the cohorts. Compared to the low volume cohort, the high volume cohort had significantly lower rates of in-hospital mortality (low volume: 11.0% vs. high volume 7.2%, p=0.005). After adjusting for potential confounders, high proceduralist volume remained significantly associated with lower odds of in-hospital death (odds ratio [OR] 0.52, 95% CI 0.36 – 0.76, p <0.05). Between the two cohorts, the difference in absolute risk of death was approximately 4.8% (p <0.05).

Conclusions Our study found that high interventionalist procedural volume, as defined by ≥18 EVT/year, was associated with reduced in-hospital morality. Further research is necessary to understand the effects of proceduralist experience and benchmarks for technical proficiency with the aim of improving the overall care of ischemic stroke patients.

Abstract O-035 Table 1

Association between stroke interventionalist annual volume and risk of in-hospital death

Abstract O-035 Figure 1

Predicted probability of in-hospital death shown by number of EVT/provider as a continuous variable. Adjusted for age (in tertiles), gender, race, NIHSS (in tertiles), Elixhauser comorbidity score, lytic therapy, primary payor, and total number of EVT procedures performed at hospital/year (in tertiles)

Disclosures A. Koo: None. D. Renedo: None. J. Ney: None. A. Amllay: None. M. Kanzler: None. S. Stogniy: None. K. W. Nowicki: None. A. Alawieh: None. N. Sujijantarat: None. J. Antonios: None. S. Al Kasab: None. R. Hebert: None. C. C. Matouk: None. A. de Havenon: None.

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