Journal of Preventive Medicine and Public Health

The Korean Society for Preventive Medicine (대한예방의학회)
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Annual Endovascular Thrombectomy Case Volume and Thrombectomy-capable Hospitals of Korea in Acute Stroke Care

  • Eun Hye Park (Graduate School of Public Health, Seoul National University) ;
  • Seung-sik Hwang (Department of Preventive Medicine, Graduate School of Public Health, Seoul National University) ;
  • Juhwan Oh (Department of Medicine, Seoul National University College of Medicine) ;
  • Beom-Joon Kim (Department of Neurology, Seoul National University Bundang Hospital) ;
  • Hee-Joon Bae (Department of Neurology, Seoul National University Bundang Hospital) ;
  • Ki-Hwa Yang (Health Insurance Review and Assessment Service) ;
  • Ah-Rum Choi (Health Insurance Review and Assessment Service) ;
  • Mi-Yeon Kang (Health Insurance Review and Assessment Service) ;
  • S.V. Subramanian (Department of Social and Behavioral Science, Harvard T.H. Chan School of Public Health)
  • Received : 2022.07.21
  • Accepted : 2023.01.31
  • Published : 2023.03.31
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Abstract

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.

Keywords

References

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