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Ischemic stroke
Original research
Higher proceduralist stroke thrombectomy volume is associated with reduced inpatient mortality
  1. Andrew B Koo1,
  2. Daniela Renedo1,
  3. John Ney2,
  4. Abdelaziz Amllay1,
  5. Matthew Kanzler1,
  6. Sasha Stogniy1,
  7. Ali M Alawieh3,
  8. Nanthiya Sujijantarat1,
  9. Joseph Antonios1,
  10. Sami Al Kasab4,
  11. Ajay Malhotra5,
  12. Ryan Hebert1,
  13. Charles Matouk1,
  14. Adam de Havenon6
    1. 1Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
    2. 2Department of Neurology, Department of Veteran's Affairs, West Haven, Connecticut, USA
    3. 3Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
    4. 4Department of Neurology and Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
    5. 5Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
    6. 6Department of Neurology, Yale Center for Brain and Mind Health, Yale School of Medicine, New Haven, Connecticut, USA
    1. Correspondence to Dr Adam de Havenon; adam.dehavenon{at}yale.edu

    Abstract

    Background The aim of this study was to determine the impact of endovascular thrombectomy (EVT) proceduralist volume on in-hospital mortality in acute ischemic stroke (AIS) patients.

    Methods We performed a retrospective cohort study using the 2020 Florida State Inpatient Database, including adult patients who had a diagnosis of AIS 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 EVTs/year/provider. Based on this cut-point, the cohort was dichotomized into low and high proceduralist volume groups. We fit logistic regression models to mortality in the full cohort, both as univariate analyses and after adjusting for covariates.

    Results Among 3143 AIS patients who underwent EVT, 1907 patients across 59 hospitals and 106 providers met our inclusion criteria. Among the providers, the median number of EVTs performed was 13.5 (IQR 7–25). The optimal cut-point was 17 EVTs. Demographics and comorbidities were similar between the cohorts. The high volume strata had a lower rate 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 (OR 0.52, 95% CI 0.36 to 0.76, P=0.001). The difference in absolute risk of death was 4.8% (P=0.005).

    Conclusions We found that high proceduralist volume, defined by ≥18 EVTs/year, was associated with reduced in-hospital morality. Further research is necessary to understand the effects of proceduralist experience and benchmarks for technical proficiency in stroke care.

    • Stroke
    • Thrombectomy

    Data availability statement

    Data are available upon reasonable request. The data are available from the Healthcare Cost and Utilization Project under the auspices of the Agency for Healthcare Research and Quality, or by the authors upon reasonable request.

    https://doi.org/10.1136/jnis-2024-022021

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      Data availability statement

      Data are available upon reasonable request. The data are available from the Healthcare Cost and Utilization Project under the auspices of the Agency for Healthcare Research and Quality, or by the authors upon reasonable request.

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      Footnotes

      • X @Jpantonios, @AjayMalhotraRad

      • Contributors All authors significantly contributed to this manuscript. Concept and design: AK, SK, AM, RH, CM, and ADH. Data acquisition: AK, JN, and ADH. Data analysis and interpretation: AK and ADH. Drafting the first manuscript: AK, DR, AA, MK, and SS. Revision of the manuscript for important intellectual content: DR, AA, NS, and JA. Guarantor of study: ADH. Approval of final manuscript version for submission: all authors.

      • 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 None declared.

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

      • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.