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

Abstract

We aimed to characterize the association of hospital procedural volumes with outcomes among acute ischemic stroke (AIS) patients undergoing endovascular therapy (EVT). 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 NIHSS <6, onset-to-treatment time >6 hours, and inter-hospital transfers. There were two secondary cohorts: (1) EVT metrics cohort: excluded patients with missing data on time from door-to-arterial-puncture; (2) Intravenous thrombolysis (IVT) metrics cohort: only included patients receiving IVT ≤4.5 hours of onset. The primary cohort (mean±SD age, 70.7 ±14.8 years; 51.2% female; median [IQR] 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. 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. This article is protected by copyright. All rights reserved.