Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
J Clin Neurosci. 2023 Aug;114:1-8. doi: 10.1016/j.jocn.2023.05.024. Epub 2023 Jun 3.
Endovascular carotid artery stenting (CAS) is a common treatment for carotid artery stenosis and stroke prevention. Previous studies have shown that high procedural volume centers are associated with improved patient outcomes. Unplanned 30-day readmissions, which are associated with significant expenses, are increasingly used as a metric of patient outcome. Despite prior studies evaluating associations between procedural volume and multiple outcomes, the association between very high CAS volume and short-term (30-day) readmission has not yet been evaluated in a large multicenter study. The National Readmissions Database (NRD) was analyzed retrospectively from 2010 to 2015 to evaluate the association between hospital procedural volume and patient outcomes in asymptomatic and symptomatic CAS patients. Very high volume centers (VHVC) were defined as the top 10% hospitals in terms of procedural volume, performing >= 79 procedures a year. Univariate and multivariate analyses of patient and hospital characteristics evaluated associations with short-term (30-day) readmissions (SR), long-term (90-day) readmissions (LR), index mortality, discharge disposition, major complications, and neurological complications. A total of 36,128 asymptomatic patients and 8,390 symptomatic patients who underwent CAS were identified. Asymptomatic CAS patients treated at VHVCs were associated with decreased likelihood of SR (OR 0.88, 95% CI 0.80-0.95, p = 0.003) and LR (OR 0.91, 95% CI 0.85-0.99, p = 0.037) compared to asymptomatic patients at non-VHVCs. There was no significant difference in SR or LR between symptomatic CAS patients treated at a VHVC vs. non-VHVC. Our findings provide additional evidence to support the role of experience in improved CAS treatment outcomes.
血管内颈动脉支架置入术（CAS）是治疗颈动脉狭窄和预防中风的常用方法。先前的研究表明，高手术量中心与改善患者预后相关。非计划性 30 天再入院与显著的费用相关，越来越多地被用作患者预后的衡量标准。尽管先前的研究评估了手术量与多种结果之间的关联，但在大型多中心研究中，尚未评估非常高的 CAS 量与短期（30 天）再入院之间的关联。从 2010 年到 2015 年，回顾性地分析了国家再入院数据库（NRD），以评估无症状和有症状的 CAS 患者中医院手术量与患者结局之间的关系。非常高容量中心（VHVC）定义为根据手术量排名前 10%的医院，每年进行>=79 例手术。对患者和医院特征的单变量和多变量分析评估了与短期（30 天）再入院（SR）、长期（90 天）再入院（LR）、指数死亡率、出院处置、主要并发症和神经并发症相关的因素。共确定了 36128 例无症状患者和 8390 例有症状患者进行了 CAS。与非 VHVC 相比，在 VHVC 接受治疗的无症状 CAS 患者发生 SR（OR 0.88，95%CI 0.80-0.95，p=0.003）和 LR（OR 0.91，95%CI 0.85-0.99，p=0.037）的可能性降低。与在非 VHVC 接受治疗的有症状 CAS 患者相比，在 VHVC 接受治疗的有症状 CAS 患者的 SR 或 LR 没有显著差异。我们的研究结果提供了更多的证据支持经验在改善 CAS 治疗结果中的作用。
