Abstract
Aim and methodsTo analyse nationwide changes in neurointerventional center size of all German hospitals performing mechanical thrombectomy (MT) in stroke patients from 2016 to 2019. Furthermore, we assessed cross-district patient migration for MT for the first time using hospitals’ structured quality reports and German Diagnosis-Related Groups data in 2019.FindingsNumber of hospitals performing more than 100 MT procedures/year doubled in Germany from 2016 (n = 36) to 2019 (n = 71), and these neurointerventional centers performed 71% of all MT procedures in 2019. The overall increase in MT procedures was largely driven by these high-volume neurointerventional centers with ability to perform MT 24/7 (121% increase as compared with 8% increase in hospitals performing less than 100 MT procedures/year). The highest cross-district patient mobility/transfer of stroke patients for MT was observed in districts adjacent to these high-volume neurointerventional centers with existing neurovascular networks.ConclusionThe substantial increase in MT procedures observed in Germany between 2016 and 2019 was almost exclusively delivered by high-volume stroke centers performing more than 100 MT procedures per year in established neurovascular networks. As there is still a reasonable number of districts with low MT rates, further structural improvement including implementation of new or expansion of existing neurovascular networks and regional tailored MT triage concepts is needed.
Highlights
The substantial increase in mechanical thrombectomy (MT) procedures observed in Germany between 2016 and 2019 was almost exclusively delivered by high-volume stroke centers performing more than 100 MT procedures per year in established neurovascular networks
> 200 MT/year assess the numbers of MT procedures performed in each German hospital and patient migration for MT between all 412 German administrative districts and cities
Number of hospitals with frequent and high volume neurointerventional centers have doubled in Germany from 2016 (n = 36) to 2019 (n = 71), and these centers performed almost three quarters (71%) of all MT procedures in 2019 (Table 1 and Fig. 1)
Summary
Conclusion: The substantial increase in MT procedures observed in Germany between 2016 and 2019 was almost exclusively delivered by high-volume stroke centers performing more than 100 MT procedures per year in established neurovascular networks. > 200 MT/year assess the numbers of MT procedures performed in each German hospital and patient migration for MT between all 412 German administrative districts and cities.
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