Tripathi Ankita, Stein Laura K, Dhamoon Mandip S
Department of Neurology, Mount Sinai Downtown, New York, NY, United States.
Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
J Stroke Cerebrovasc Dis. 2023 Feb;32(2):106943. doi: 10.1016/j.jstrokecerebrovasdis.2022.106943. Epub 2022 Dec 13.
Endovascular thrombectomy (ET) has become the standard of stroke care for large vessel occlusion acute ischemic stroke (AIS) involving the anterior circulation. With continued eligibility expansion, the demand for neuro-intervention is growing. Current estimates indicate inadequate supply of interventionalists. However, there is limited data describing the number of interventionalists per hospital in the US, and correlations with outcomes.
We used Medicare 100% sample datasets and included all AIS admissions from 2018 to 2019, using validated International Classification of Diseases, 10th Revision, Clinical Modification codes to identify AIS and comorbidities. We utilized National Provider Identifier codes to identify distinct interventionalists at the hospital. We examined outcomes at the hospital level, including percent of AIS treated with thrombolysis, percent of AIS with inpatient mortality, percent of AIS with discharge home, and percent of AIS with death within 30 days.
Among 471,427 AIS admissions, 16,253 received ET over the 2-year period of the study. Only 683 of 4576 AIS-treating institutions provided ET (14.9%). These ET centers most frequently only had one interventionalist performing ET and were clustered in large metropolitan areas with high AIS volumes. As AIS volumes, ET volumes, and mean NIHSS scores increased, so did the number of interventionalists. With each additional interventionalist, there was an increased likelihood of poor outcomes including inpatient mortality, discharge home, and 30-day mortality.
We confirmed a relative lack of neuro-interventionalists among US hospitals, with a concentration of interventionalists in urban, high-volume centers. The greater likelihood of poor outcomes associated with increasing number of interventionalists is likely due to increasing complexity and severity of cases at high-volume ET centers, but further study is needed.
血管内血栓切除术（ET）已成为涉及前循环的大血管闭塞急性缺血性卒中（AIS）的卒中治疗标准。随着符合治疗条件的患者不断增加，神经介入治疗的需求也在增长。目前的估计表明介入医生供应不足。然而，关于美国每家医院介入医生数量及其与治疗结果相关性的数据有限。
我们使用了医疗保险100%样本数据集，纳入了2018年至2019年所有AIS住院病例，使用经过验证的国际疾病分类第十版临床修订版代码来识别AIS和合并症。我们利用国家提供者识别码来识别医院中不同的介入医生。我们在医院层面检查了治疗结果，包括接受溶栓治疗的AIS百分比、住院死亡率的AIS百分比、出院回家的AIS百分比以及30天内死亡的AIS百分比。
在471427例AIS住院病例中，在研究的2年期间有16253例接受了ET治疗。4576家治疗AIS的机构中只有683家提供ET（14.9%）。这些ET中心大多数通常只有一名介入医生进行ET治疗，并且集中在AIS病例数量多的大城市地区。随着AIS病例数量、ET治疗数量和平均美国国立卫生研究院卒中量表（NIHSS）评分的增加，介入医生的数量也增加。每增加一名介入医生，包括住院死亡率、出院回家率和30天死亡率在内的不良结果的可能性就增加。
我们证实美国医院中相对缺乏神经介入医生，介入医生集中在城市的高病例量中心。介入医生数量增加与不良结果可能性增加可能是由于高病例量ET中心病例的复杂性和严重性增加，但仍需要进一步研究。
