Abstract Details

Title Characteristics of Low-Volume Stroke Thrombectomy Centers in Florida

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P10 - Poster Session 10 (5:00 PM-6:00 PM)

Poster/Presentation
Number 13-019

Objective To evaluate patient- and hospital-level characteristics of low-volume stroke thrombectomy (ST) centers.

Background Thrombectomy is an effective treatment for large vessel occlusion stroke but requires trained operators and a capable center. Although accreditation organizations have set minimum ST volume requirements for stroke center certification, low-volume ST centers could nevertheless play an important role in stroke systems of care. The characteristics of such centers are not well-known.

Design/Methods Using data from the Florida Healthcare Cost & Utilization Project and the American Hospital Association Annual Survey, we identified all hospitalizations of adult Florida residents in 2018-19 with a principal diagnosis of acute ischemic stroke who received ST. We stratified cases by whether the procedure was done at a center performing fewer than 15 ST procedures per year averaged over 2016-19. We compared the patient and hospital characteristics according to center volume and evaluated outcomes at discharge using a multivariate model.

Results Among 5814 patients treated with ST at 80 centers, 355 (6.1%) were treated at 37 low-volume ST centers. These patients were more often White and less often Black or Hispanic, were less likely to reside in low-income zip codes, and more frequently lived in metropolitan cores (p<0.001). Low-volume hospitals had lower bed counts and were less frequently teaching hospitals (p<0.001). The median (IQR) travel time to the nearest higher-volume center was 24.9 (12.4-33.6) minutes. In adjusted models, there were no differences in discharge outcomes (in-hospital mortality or hospice discharge: OR 0.87, 95% CI 0.59-1.28; not discharged home: OR 1.07, 95% CI 0.77-1.48) at low-volume versus higher-volume centers.

Conclusions Patients treated at low-volume ST centers in Florida were less often Black or Hispanic and less likely to live in low-income and ex-urban areas. Outcomes after ST were not discernibly different. These findings may indicate more stringent patient selection at low-volume centers but raise concern about access disparities.

Authors/Disclosures
Nathaniel Fleming, MD (UCSF Neurology) PRESENTER	Dr. Fleming has nothing to disclose.
Liza Solovey, MD	Liza Solovey, MD has nothing to disclose.
Renee Hsia, MD	The institution of Dr. Hsia has received research support from NHLBI. The institution of Dr. Hsia has received research support from NIMHD. The institution of Dr. Hsia has received research support from NIA.
Yu-Chu Shen, PhD	The institution of Dr. Shen has received research support from Defense Health Agency. The institution of Dr. Shen has received research support from National Institute of Health.
Anthony S. Kim, MD (UCSF Department of Neurology)	Dr. Kim has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for New England Journal of Medicine: Journal Watch. Dr. Kim has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Quintairos, Prieto, Wood & Boyer, PA. The institution of Dr. Kim has received research support from NIH/NCATS. The institution of Dr. Kim has received research support from NIH/NINDS. The institution of Dr. Kim has received research support from NIH/NIHMD. The institution of Dr. Kim has received research support from Patient-Centered Outcome Research Institute. The institution of Dr. Kim has received research support from American Heart Association. Dr. Kim has received personal compensation in the range of $500-$4,999 for serving as a Speaker with American Neurological Association.

��ɫ��

��ɫ��