- Annual Endovascular Thrombectomy Case Volume and Thrombectomy-capable Hospitals of Korea in Acute Stroke Care
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Eun Hye Park, Seung-sik Hwang, Juhwan Oh, Beom-Joon Kim, Hee-Joon Bae, Ki-Hwa Yang, Ah-Rum Choi, Mi-Yeon Kang, S.V. Subramanian
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J Prev Med Public Health. 2023;56(2):145-153. Published online March 31, 2023
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DOI: https://doi.org/10.3961/jpmph.22.318
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 Abstract
Summary
 PDF Supplementary Material
- 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.
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Summary
Korean summary
급성 허혈성 뇌졸중 환자에서 “혈관 내 혈전제거술(endovascular treatment, EVT)”의 치료효과는 여러 연구를 통해 증명되었으나, EVT 후보군에서 EVT를 제공하기 위한 의료서비스 연구는 부족한 실정이다. 5~7차 뇌졸중 적정성 평가 자료를 활용하여 연간 EVT 시행횟수와 EVT후보군의 30일, 1년 후 치명률 간의 연관성을 다수준 분석을 통해 확인하였다. 연간 15회 이상 EVT를 시행하면서 뇌졸중 전문치료실과 뇌줄중 관련 전문분과(신경과, 신경외과, 재활의학과) 전문의가 모두 있는 병원(TCHs)에서 치료받은 환자는 EVT를 시행하지 않는 병원(PSHs-without-EVT)에서 치료받는 환자에 비해 치명률이 감소하는 경향을 보였다. 이는 뇌졸중 치료체계에서 EVT가능병원을 정의할 필요성을 잘 보여주고, “연간 EVT 시행횟수”는 TCHs를 정의하는 중요한 지표로 사용될 수 있을 것이다.
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