Solovey Liza, Hsia Renee Y, Shen Yu-Chu, Guterman Elan L, Choi Jay Chol, Kim Anthony S
UCSF Weill Institute for Neurosciences, Department of Neurology (LS, ELG, ASK), Department of Emergency Medicine (RYH); Philip R. Lee Institute for Health Policy Studies (RYH, ELG), University of California, San Francisco; Naval Postgraduate School (Y-CS), Monterey, CA; National Bureau of Economic Research (Y-CS), Cambridge, MA; and Department of Neurology (JCC), School of Medicine, Jeju National University, Korea.
Neurol Clin Pract. 2024 Dec;14(6):e200337. doi: 10.1212/CPJ.0000000000200337. Epub 2024 Sep 11.
Mechanical thrombectomy (MT) improves outcomes for acute ischemic stroke (AIS) due to large vessel occlusion, but is time sensitive and requires specialized infrastructure. Professional organizations and certification bodies have promulgated minimum procedural volume standards for centers and for individual proceduralists but it is unclear whether enforcing these requirements would decrease geographic access to MT. Therefore, we sought to evaluate the potential impact of applying a minimum procedural volume threshold on geographic access to MT.
We identified all hospital discharges for stroke where an MT procedure was performed at any nonfederal hospital in Florida in 2019 using statewide hospital discharge data. We then generated geographic service area maps based on prespecified ground transport distances for the subset of hospitals that performed at least 1 MT and for those that performed at least 15 MTs that year, the minimum volume threshold required for thrombectomy capable and comprehensive stroke centers by the Joint Commission. Then, using zip code centroids and patient-level discharge hospital data, we computed the proportion of patients with AIS who lived within each of the generated service areas.
A total of 105 of 297 hospitals performed MT; of those, 51 (17%) were low-volume centers (1-14 MTs/year) and 54 (18%) were high-volume centers (≥15 MTs/year). High-volume centers accounted for nearly 95% of all MTs performed in the state. Most patients hospitalized with AIS (87%) lived within 20 miles (or an estimated as a 1-hour driving time) of a hospital that performed at least 1 MT, and all (100%) lived within 115 miles (or estimated as 3-hour driving time). Setting a minimum MT volume threshold of 15 would decrease the proportion of stroke patients living within 1-hour driving time of an MT center from 87% to 77%.
In 2019, most Florida stroke patients lived within a 1-hour ground transport time to a center that performed at least 1 MT and all lived within 3-hour driving time of an MT center, irrespective of whether a minimum procedural volume threshold of 15 cases per year was applied or not.
机械取栓术（MT）可改善因大血管闭塞导致的急性缺血性卒中（AIS）的预后，但具有时间敏感性且需要专门的基础设施。专业组织和认证机构已颁布了针对中心和个体手术医生的最低手术量标准，但尚不清楚强制执行这些要求是否会减少MT的地理可及性。因此，我们试图评估应用最低手术量阈值对MT地理可及性的潜在影响。
我们利用全州医院出院数据，确定了2019年在佛罗里达州任何一家非联邦医院进行MT手术的所有卒中患者出院情况。然后，我们根据预先指定的地面运输距离，为当年至少进行1例MT手术的医院子集以及至少进行15例MT手术的医院子集（联合委员会要求的取栓能力中心和综合卒中中心的最低手术量阈值）生成地理服务区地图。然后，使用邮政编码中心和患者层面的出院医院数据，我们计算了居住在每个生成服务区内的AIS患者的比例。
297家医院中有105家进行了MT手术；其中，51家（17%）是低手术量中心（每年1 - 14例MT手术），54家（18%）是高手术量中心（每年≥15例MT手术）。高手术量中心占该州所有MT手术的近95%。大多数因AIS住院的患者（87%）居住在距离至少进行1例MT手术的医院20英里（或估计为1小时驾车时间）范围内，并且所有患者（100%）居住在距离MT中心115英里（或估计为3小时驾车时间）范围内。将最低MT手术量阈值设定为15例，将使居住在距离MT中心1小时驾车时间范围内的卒中患者比例从87%降至77%。
2019年，佛罗里达州的大多数卒中患者居住在距离至少进行1例MT手术的中心1小时地面运输时间范围内，并且所有患者居住在距离MT中心3小时驾车时间范围内，无论是否应用每年15例的最低手术量阈值。
