Lorenzo Rinaldo1, Waleed Brinjikji1, Alejandro A Rabinstein2. 1. From the Department of Neurosurgery (L.R.), Department of Radiology (W.B.), and Department of Neurology (A.A.R.), Mayo Clinic, Rochester, MN. 2. From the Department of Neurosurgery (L.R.), Department of Radiology (W.B.), and Department of Neurology (A.A.R.), Mayo Clinic, Rochester, MN. rabinstein.alejandro@mayo.edu.
Abstract
BACKGROUND AND PURPOSE: Some have argued that it may be beneficial to expand the availability of endovascular revascularization services to lower-volume hospitals to minimize the morbidity associated with transfer to larger endovascular centers. We compared the outcomes after revascularization of patients directly admitted to a low-volume center and those transferred to a high-volume center. METHODS: We searched a national database of hospital-reported outcomes for patients who underwent endovascular revascularization for acute ischemic stroke. Hospitals were categorized as low, medium, or high procedural volume hospitals. Outcomes of inpatient admissions were collected and compared on the basis of admission source and hospital procedural volume. RESULTS: A total of 118 institutions with 8533 patients were included. Mortality rate (14.9% versus 18.6%; P=0.049) and mortality index (1.1 versus 1.6; P=0.048) were significantly lower among directly admitted relative to transferred patients. For all patients, there were significant differences in institutional mortality rate (low: 19.7%, medium: 14.9%, high: 9.8%; P=0.003) and mortality index (low: 1.5, medium: 1.1, high: 0.8; P=0.004) between low-, medium-, and high-volume hospitals. For transferred patients to high-volume centers, both mortality rate (high: 10.0% versus low: 20.4%; P=0.005) and mortality index (high: 0.8 versus low: 1.5; P=0.034) were significantly lower than that observed for directly admitted patients to low-volume hospitals. CONCLUSIONS: We report a beneficial effect of treatment at high-volume hospitals in spite of the detrimental effects of transfer. These findings argue for the centralization of care.
BACKGROUND AND PURPOSE: Some have argued that it may be beneficial to expand the availability of endovascular revascularization services to lower-volume hospitals to minimize the morbidity associated with transfer to larger endovascular centers. We compared the outcomes after revascularization of patients directly admitted to a low-volume center and those transferred to a high-volume center. METHODS: We searched a national database of hospital-reported outcomes for patients who underwent endovascular revascularization for acute ischemic stroke. Hospitals were categorized as low, medium, or high procedural volume hospitals. Outcomes of inpatient admissions were collected and compared on the basis of admission source and hospital procedural volume. RESULTS: A total of 118 institutions with 8533 patients were included. Mortality rate (14.9% versus 18.6%; P=0.049) and mortality index (1.1 versus 1.6; P=0.048) were significantly lower among directly admitted relative to transferred patients. For all patients, there were significant differences in institutional mortality rate (low: 19.7%, medium: 14.9%, high: 9.8%; P=0.003) and mortality index (low: 1.5, medium: 1.1, high: 0.8; P=0.004) between low-, medium-, and high-volume hospitals. For transferred patients to high-volume centers, both mortality rate (high: 10.0% versus low: 20.4%; P=0.005) and mortality index (high: 0.8 versus low: 1.5; P=0.034) were significantly lower than that observed for directly admitted patients to low-volume hospitals. CONCLUSIONS: We report a beneficial effect of treatment at high-volume hospitals in spite of the detrimental effects of transfer. These findings argue for the centralization of care.
Authors: Radoslav I Raychev; Dana Stradling; Nirav Patel; Joey R Gee; David A Lombardi; Johnson L Moon; David M Brown; Mayank Pathak; Wengui Yu; Samuel J Stratton; Steven C Cramer Journal: Stroke Date: 2018-04-06 Impact factor: 7.914
Authors: Laurent Pierot; Mahesh V Jayaraman; Istvan Szikora; Joshua A Hirsch; Blaise Baxter; Shigeru Miyachi; Jeyaledchumy Mahadevan; Winston Chong; Peter J Mitchell; Alan Coulthard; Howard A Rowley; Pina C Sanelli; Donatella Tampieri; Patrick A Brouwer; Jens Fiehler; Naci Kocer; Pedro Vilela; Alex Rovira; Urs Fischer; Valeria Caso; Bart van der Worp; Nobuyuki Sakai; Yuji Matsumaru; Shin-Ichi Yoshimura; Rene Anxionnat; Hubert Desal; Luisa Biscoito; José Manuel Pumar; Orlando Diaz; Justin F Fraser; Italo Linfante; David S Liebeskind; Raul G Nogueira; Werner Hacke; Michael Brainin; Bernard Yan; Michael Soderman; Allan Taylor; Sirintara Pongpech; Michihiro Tanaka; Terbrugge Karel Journal: Interv Neuroradiol Date: 2018-10-23 Impact factor: 1.610
Authors: Laurent Pierot; Mahesh V Jayaraman; Istvan Szikora; Joshua A Hirsch; Blaise Baxter; Shigeru Miyachi; Jeyaledchumy Mahadevan; Winston Chong; Peter J Mitchell; Alan Coulthard; Howard A Rowley; Pina C Sanelli; Donatella Tampieri; Patrick A Brouwer; Jens Fiehler; Naci Kocer; Pedro Vilela; Alex Rovira; Urs Fischer; Valeria Caso; Bart van der Worp; Nobuyuki Sakai; Yuji Matsumaru; Shin-Ichi Yoshimura; Rene Anxionnat; Hubert Desal; Luisa Biscoito; José Manuel Pumar; Orlando Diaz; Justin F Fraser; Italo Linfante; David S Liebeskind; Raul G Nogueira; Werner Hacke; Michael Brainin; Bernard Yan; Michael Soderman; Allan Taylor; Sirintara Pongpech; Michihiro Tanaka; Karel Terbrugge Journal: AJNR Am J Neuroradiol Date: 2018-11 Impact factor: 3.825
Authors: Y Mayasi; R P Goddeau; M Moonis; B Silver; A H Jun-O'Connell; A S Puri; N Henninger Journal: AJNR Am J Neuroradiol Date: 2017-11-23 Impact factor: 3.825
Authors: Hamidreza Saber; Babak B Navi; James C Grotta; Hooman Kamel; Arvind Bambhroliya; Farhaan S Vahidy; Peng Roc Chen; Spiros Blackburn; Sean I Savitz; Louise McCullough; Sunil A Sheth Journal: Stroke Date: 2019-03 Impact factor: 7.914
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