Annual Endovascular Thrombectomy Case Volume and Thrombectomy-capable Hospitals of Korea in Acute Stroke Care

Park Eun Hye; Hwang Seung-sik; Oh Juhwan; Kim Beom Joon; Bae Hee-Joon; Yang Ki Hwa; Choi Ah Rum; Kang Mi Yeon; Subramanian S.V.

doi:10.3961/jpmph.22.318

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자료유형: 학술저널

저자정보: Park Eun Hye (Graduate School of Public Health Seoul National University Seoul Korea) Hwang Seung-sik (Department of Preventive Medicine Graduate School of Public Health Seoul National University Seoul) Oh Juhwan (Department of Medicine Seoul National University College of Medicine Seoul Korea) Kim Beom Joon (Department of Neurology Seoul National University Bundang Hospital SeongnamKorea) Bae Hee-Joon (Department of Neurology Seoul National University Bundang Hospital Seongnam Korea.) Yang Ki Hwa (Health Insurance Review and Assessment Service Wonju Korea.) Choi Ah Rum (Health Insurance Review and Assessment Service Wonju Korea.) Kang Mi Yeon (Health Insurance Review and Assessment Service Wonju Korea.) Subramanian S.V. (Department of Social and Behavioral Science Harvard T.H. Chan School of Public Health Boston MA USA)

저널정보: 대한예방의학회 예방의학회지 예방의학회지 제56권 제2호

발행연도: 2023.3

수록면: 145 - 153 (9page)

DOI: 10.3961/jpmph.22.318

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Objectives: Although it is difficult to define the quality of stroke care, acute ischemic stroke (AIS) patients with moderate-to-severe neurological deficits may benefit from thrombectomy-capable hospitals (TCHs) that have a stroke unit, stroke specialists, and a substantial endovascular thrombectomy (EVT) case volume.Methods: From national audit data collected between 2013 and 2016, potential EVT candidates arriving within 24 hours with a baseline National Institutes of Health Stroke Scale score ≥6 were identified. Hospitals were classified as TCHs (≥15 EVT case/y, stroke unit, and stroke specialists), primary stroke hospitals (PSHs) without EVT (PSHs-without-EVT, 0 case/y), and PSHs-with-EVT. Thirty-day and 1-year case-fatality rates (CFRs) were analyzed using random intercept multilevel logistic regression.Results: Out of 35 004 AIS patients, 7954 (22.7%) EVT candidates were included in this study. The average 30-day CFR was 16.3% in PSHs-without-EVT, 14.8% in PSHs-with-EVT, and 11.0% in TCHs. The average 1-year CFR was 37.5% in PSHs-without-EVT, 31.3% in PSHs-with-EVT, and 26.2% in TCHs. In TCHs, a significant reduction was not found in the 30-day CFR (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.76 to 1.12), but was found in the 1-year CFR (OR, 0.84; 95% CI, 0.73 to 0.96).Conclusions: The 1-year CFR was significantly reduced when EVT candidates were treated at TCHs. TCHs are not defined based solely on the number of EVTs, but also based on the presence of a stroke unit and stroke specialists. This supports the need for TCH certification in Korea and suggests that annual EVT case volume could be used to qualify TCHs.

#Stroke #Cerebral infarction #Endovascular procedures #Quality of healthcare #Epidemiology

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