Nogueira Raul G, Haussen Diogo C, Smith Eric E, Sun Jie-Lena, Xian Ying, Alhanti Brooke, Blanco Rosalia, Mac Grory Brian, Doheim Mohamed F, Bhatt Deepak L, Fonarow Gregg C, Hassan Ameer E, Joundi Raed A, Mocco J, Frankel Michael R, Schwamm Lee H
Departments of Neurology and Neurosurgery, University of Pittsburgh Medical Center Stroke Institute, University of Pittsburgh, Pittsburgh, PA, USA.
Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA, USA.
Ann Neurol. 2023 Sep 20. doi: 10.1002/ana.26803.
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 National Institutes of Health Stroke Scale (NIHSS) < 6, onset-to-treatment time > 6 hours, and interhospital transfers. There were 2 secondary cohorts: (1) the EVT metrics cohort excluded patients with missing data on time from door to arterial puncture and (2) the intravenous thrombolysis (IVT) metrics cohort only included patients receiving IVT ≤4.5 hours after onset.
The primary cohort (mean ± standard deviation age = 70.7 ± 14.8 years; 51.2% female; median [interquartile range] 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. ANN NEUROL 2023.
我们旨在描述接受血管内治疗（EVT）的急性缺血性卒中（AIS）患者的医院手术量与预后之间的关联。
这是一项回顾性观察队列研究，使用了2016年1月1日至2019年12月31日在“遵循卒中指南”注册研究中前瞻性收集的数据。参与者来自626家医院在24小时内接受EVT治疗的60727例AIS患者队列。主要队列排除了治疗前美国国立卫生研究院卒中量表（NIHSS）评分<6分、发病至治疗时间>6小时以及院间转运的患者。有2个次要队列：（1）EVT指标队列排除了从入院到动脉穿刺时间数据缺失的患者；（2）静脉溶栓（IVT）指标队列仅包括发病后≤4.5小时接受IVT治疗的患者。
主要队列（平均±标准差年龄=70.7±14.8岁；51.2%为女性；基线NIHSS中位数[四分位间距]=18.0[13 - 22]；IVT使用率为70.2%）包括595家医院的21209例患者。EVT指标队列和IVT指标队列分别包括408家和601家医院的47262例和16889例患者。更高的手术量与出院回家的更高几率（每增加10例手术量的调整优势比[95%置信区间]表示）（1.03[1.02 - 1.04]）、出院时功能独立（1.02[1.01 - 1.04]）以及更低的院内死亡率（0.96[0.95 - 0.98]）显著相关。所有次要指标也与手术量相关。
在主要就诊于具备EVT能力医院的AIS患者中（不包括从一个机构转至另一个机构的患者以及院内发生卒中的患者），手术量较高的医院进行的EVT与更快的治疗时间、更好的出院结局以及更低的院内死亡率相关。《神经病学年鉴》2023年。
