Trends in Utilization and Impact of Hospital Procedural Volume on Mortality after Endovascular Thrombectomy for Acute Ischemic Stroke.

Abstract

Objectives: Endovascular thrombectomy (EVT) has become an established treatment for eligible acute ischemic stroke (AIS) patients, but data on mortality trends and the association between procedural volume and outcomes in the United States is limited.

Materials and methods: This retrospective study analyzed data from the Nationwide Readmissions Database (NRD) to investigate trends in EVT utilization, outcomes, and the relationship between hospital procedural volume and inpatient mortality for AIS admissions between 2016-2020. Patients undergoing EVT were identified using ICD-10 procedure codes. Hospitals were categorized into quintiles based on EVT volumes, and mortality rates compared across quintiles. Multivariable regression identified predictors of mortality.

Results: Of 2,535,777 AIS admissions, 90,110 (3.6%) underwent EVT (median age of 70 and 50% female in both groups). EVT utilization increased from 2.8% in 2016 to 3.9% in 2020 (p<0.001). Patients receiving EVT had higher prevalence of atrial fibrillation and coronary artery disease but lower rates of hyperlipidemia and tobacco use. Inpatient mortality was higher with EVT (13% vs 4%, p<0.001) but declined from 16% in 2016-2017 to 12% in 2020 (p<0.001). Hemiparalysis and atrial fibrillation were associated with higher EVT likelihood. Mortality decreased with higher hospital EVT volume. After adjustment, higher procedural centers were associated with lower mortality.

Conclusion: EVT utilization for AIS increased nationally from 2016-2020 while associated mortality declined. Higher hospital procedural volumes were associated with lower mortality.