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Original research
Stroke thrombectomy volume, rather than stroke center accreditation status of hospitals, is associated with mortality and discharge disposition
  1. Muhammad Waqas1,2,
  2. Vincent M Tutino3,4,
  3. Justin M Cappuzzo1,2,
  4. Victoria Lazarov5,
  5. Daniel Popoola5,
  6. Tatsat R Patel4,
  7. Bennett R Levy6,
  8. Andre Monteiro1,2,
  9. Maxim Mokin7,8,
  10. Ansaar T Rai9,
  11. J Mocco10,
  12. Aquilla S Turk11,
  13. Kenneth V Snyder2,12,
  14. Jason M Davies2,13,
  15. Elad I Levy2,14,
  16. Adnan H Siddiqui2,14
  1. 1 Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
  2. 2 Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
  3. 3 Department of Neurosurgery, Pathology and Anatomical Sciences, and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
  4. 4 Department of Biomedical Engineering, University at Buffalo, Buffalo, New York, USA
  5. 5 Medical Student, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
  6. 6 Medical Student, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
  7. 7 Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, USA
  8. 8 Neurosciences Center, Tampa General Hospital, Tampa, Florida, USA
  9. 9 Department of Interventional Neuroradiology, West Virginia University Rockefeller Neuroscience Institute, Morgantown, West Virginia, USA
  10. 10 Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  11. 11 Department of Neurosurgery, Prisma Health Upstate, Greenville, South Carolina, USA
  12. 12 Department of Neurosurgery and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
  13. 13 Department of Neurosurgery and Bioinformatics and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
  14. 14 Department of Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
  1. Correspondence to Dr Adnan H Siddiqui, Department of Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA; asiddiqui{at}ubns.com

Abstract

Background Few studies have explored the association between stroke thrombectomy (ST) volume and hospital accreditation with clinical outcomes.

Objective To assess the association of ST case volume and accreditation status with in-hospital mortality and home discharge disposition using the national Medicare Provider Analysis and Review (MEDPAR) database.

Methods Rates of hospital mortality, home discharge disposition, and hospital stay were compared between accredited and non-accredited hospitals using 2017–2018 MEDPAR data. The association of annual ST case volume with mortality and home disposition was determined using Pearson’s correlation. Median rate of mortality and number of ST cases at hospitals within the central quartiles were estimated.

Results A total of 29 355 cases were performed over 2 years at 847 US centers. Of these, 354 were accredited. There were no significant differences between accredited and non-accredited centers for hospital mortality (14.8% vs 14.5%, p=0.34) and home discharge (12.1% vs 12.0%, p=0.78). A significant positive correlation was observed between thrombectomy volume and home discharge (r=0.88; 95% CI 0.58 to 0.97, p=0.001). A significant negative relationship was found between thrombectomy volume and mortality (r=−0.86; 95% CI −0.97 to −0.49, p=0.002). Within the central quartiles, the median number of ST cases at hospitals with mortality was 24/year, and the median number of ST cases at hospitals with home discharge rate was 23/year.

Conclusion A higher volume of ST cases was associated with lower mortality and higher home discharge rate. No significant differences in mortality and discharge disposition were found between accredited and non-accredited hospitals.

  • stroke
  • thrombectomy

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. The data that support the findings of this study are available from the corresponding author on reasonable request.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. The data that support the findings of this study are available from the corresponding author on reasonable request.

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Footnotes

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  • Collaborators Not applicable.

  • Contributors Conception and design: AHS, MW. Acquisition of the data: all authors. Analysis and interpretation of the data: all authors. Drafting the manuscript: MW. Critically revising the manuscript: all authors. Reviewed submitted version of manuscript: all authors. AHS is the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests Competing Interests: MW, VMT, JMC, VL, DP, TRP, AM: None. BRL: Neurosurgery Research and Education Foundation grant contribution to University at Buffalo Neurosurgery Department. MM: grant: NIHR21NS109575 (did not fund this study); consultant: Medtronic, Cerenovus; leadership or fiduciary role in other board, society, committee, or advocacy group; Assistant Editor: Technical Videos, JNIS Editorial Board; Stock options: BrainQ, Endostream, Serenity Medical, SynchronATR: Consulting agreement: Stryker, Cerenovus, MicroVentionJM: Grants/non-salary research support from Stryker, MicroVention, and Penumbra (PI on their trials); Consulting fees: Cerebrotech, Viseon, Endostream, Vastrax, RIST, Synchron, Viz.ai, Perflow, and CVAid; Payment or honoraria: Invited speaker at Barrow Neurological Institute Grand Rounds (March 2020); Leadership or fiduciary role in other board, society, committee or advocacy group: Associate Editor, Editorial Board JNIS, President-Elect, Board of Directors SNIS; Stock or stock options: Cerebrotech, Imperative Care, Endostream, Viseon, BlinkTBI, Myra Medical, Serenity, Vastrax, NTI, RIST, Viz.ai, Synchron, Radical, and Truvic.AST: Stock: Bend IT Technologies, Ltd., BlinkTBI, Inc, Cardinal Consultants, LLC, Cerebrotech Medical Systems, Inc, Endostream Medical, Ltd, Imperative Care, Inc., Instylla, Inc., Neurotechnology Investors, Q’Apel Medical, Inc., Radical Catheter Technologies, Inc., Rist Neurovascular, Inc. (Purchased 2020 by Medtronic), Serenity Medical, Inc., Spinnaker Medical, Inc., Synchron, Inc., Three Rivers Medical, Inc., Truvic Medical, Inc., Tulavi Therapeutics, Inc., Vastrax, LLC, VICIS, Inc., Viz AI; Consultant/Advisory Board: Cerebrotech Medical Systems, Inc., Endostream Medical, Ltd, Imperative Care, Medtronic, Serenity Medical, Inc., Three Rivers Medical, Inc., Viz.ai, Inc.; National PI/Steering Committees: COMPASS, POSITIVE, LARGE trialsKVS: Consulting Fees: Boston Scientific, Canon Medical Systems USA, Inc., MicroVention, Medtronic, Stryker Neurovascular. Payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing, or educational event: Canon Medical Systems USA Inc. Stock or stock options: Boston Scientific, Access Closure Inc, Niagara Gorge Medical.JMD: Consulting fees; payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing, or educational events; support for attending meetings and/or travel: Medtronic. Patents planned, issued, or pending: QAS.ai. Participation on a Data Safety Monitoring Board or Advisory Board: NIH NIHDS Strokenet. Stock or stock options: Synchron, Cerebrotech, QAS.aiEIL: Consulting fees: Claret Medical, GLG Consulting, Guidepoint Global, Imperial Care, Medtronic, Rebound, StimMed, Misionix, Mosiac, Clarion, IRRAS. Payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events: Medtronic; Payment for expert testimony: for rendering medical/legal opinions as an expert. Support for attending meetings and/or travel: Reimbursement for travel and food for some meetings with the CNS and ABNS. Stock or stock options: NeXtGen Biologics, RAPID Medical, Claret Medical, Cognition Medical, Imperative Care, Rebound Therapeutics, StimMed, Three Rivers Medical.AHS: Consulting fees: Amnis Therapeutics, Apellis Pharmaceuticals, Inc., Boston Scientific, Canon Medical Systems USA, Inc., Cardinal Health 200, LLC, Cerebrotech Medical Systems, Inc., Cerenovus, Cerevatech Medical, Inc., Cordis, Corindus, Inc., Endostream Medical, Ltd, Imperative Care, Integra, IRRAS AB, Medtronic, MicroVention, Minnetronix Neuro, Inc., Penumbra, Q’Apel Medical, Inc., Rapid Medical, Serenity Medical, Inc., Silk Road Medical, StimMed, LLC, Stryker Neurovascular, Three Rivers Medical, Inc., VasSol, Viz.ai, Inc., W.L. Gore & Associates. Leadership or fiduciary role in other board, society, committee or advocacy group: Past Secretary of the Board of the Society of NeuroInterventional Surgery (2020-2021), Chair of the Cerebrovascular Section of the AANS/CNS. Stock or stock options: Adona Medical, Inc., Amnis Therapeutics, Bend IT Technologies, Ltd., BlinkTBI, Inc, Buffalo Technology Partners, Inc., Cardinal Consultants, LLC, Cerebrotech Medical Systems, Inc, Cerevatech Medical, Inc., Cognition Medical, CVAID Ltd., E8, Inc., Endostream Medical, Ltd, Imperative Care, Inc., Instylla, Inc., International Medical Distribution Partners, Launch NY, Inc., NeuroRadial Technologies, Inc., Neurotechnology Investors, Neurovascular Diagnostics, Inc., PerFlow Medical, Ltd., Q’Apel Medical, Inc., QAS.ai, Inc., Radical Catheter Technologies, Inc., Rebound Therapeutics Corp. (Purchased 2019 by Integra Lifesciences, Corp), Rist Neurovascular, Inc. (Purchased 2020 by Medtronic), Sense Diagnostics, Inc., Serenity Medical, Inc., Silk Road Medical, Adona Medical, Inc., Amnis Therapeutics, Bend IT Technologies, Ltd., BlinkTBI, Inc, Buffalo Technology Partners, Inc., Cardinal Consultants, LLC, Cerebrotech Medical Systems, Inc, Cerevatech Medical, Inc., Cognition Medical, CVAID Ltd., E8, Inc., Endostream Medical, Ltd, Imperative Care, Inc., Instylla, Inc., International Medical Distribution Partners, Launch NY, Inc., NeuroRadial Technologies, Inc., Neurotechnology Investors, Neurovascular Diagnostics, Inc., PerFlow Medical, Ltd., Q’Apel Medical, Inc., QAS.ai, Inc., Radical Catheter Technologies, Inc., Rebound Therapeutics Corp. (Purchased 2019 by Integra Lifesciences, Corp), Rist Neurovascular, Inc. (Purchased 2020 by Medtronic), Sense Diagnostics, Inc., Serenity Medical, Inc., Silk Road Medical, SongBird Therapy, Spinnaker Medical, Inc., StimMed, LLC, Synchron, Inc., Three Rivers Medical, Inc., Truvic Medical, Inc., Tulavi Therapeutics, Inc., Vastrax, LLC, VICIS, Inc., Viseon, Inc. Other financial or non-financial interests: National PI/Steering Committees: Cerenovus EXCELLENT and ARISE II Trial; Medtronic SWIFT PRIME, VANTAGE, EMBOLISE and SWIFT DIRECT Trials; MicroVention FRED Trial & CONFIDENCE Study; MUSC POSITIVE Trial; Penumbra 3D Separator Trial, COMPASS Trial, INVEST Trial, MIVI neuroscience EVAQ Trial; Rapid Medical SUCCESS Trial; InspireMD C-GUARDIANS IDE Pivotal Trial.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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