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Updated: Nov 3, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Correlations Between Physician and Hospital Stroke Thrombectomy Volumes and Outcomes: A Nationwide Analysis
Laura K Stein1, J Mocco2, Johanna Fifi1,2
1Department of Neurology (L.K.S., J.F., N.J., S.T., M.S.D.), Icahn School of Medicine at Mount Sinai, NY.
Insights
Higher stroke thrombectomy case volumes for proceduralists and hospitals are linked to better patient outcomes, including lower mortality and improved recovery. These findings support volume requirements for stroke thrombectomy training and certification.
Area of Science:
- Neurology
- Public Health
- Health Services Research
Background:
- The Joint Commission mandates ≥15 stroke thrombectomy (ST) cases annually per center and proceduralist.
- The association between ST case volumes and patient outcomes remains unclear.
- Investigating volume thresholds is crucial for optimizing ST care.
Purpose of the Study:
- To determine if proceduralist or hospital volume thresholds correlate with improved outcomes in Medicare beneficiaries undergoing ST.
- To analyze the impact of ST case volume on patient mortality and functional recovery.
Main Methods:
- Retrospective cohort study utilizing national Medicare inpatient data (2016-2017).
- Identified acute ischemic stroke patients treated with ST using ICD-10-CM codes.
- Performed adjusted logistic regression to assess the relationship between proceduralist/hospital volume and inpatient mortality, good outcome, and 30-day readmission.
Main Results:
- Higher proceduralist volume showed lower inpatient mortality (aOR 0.96 per 10 cases) and better outcomes (aOR 1.03 per 10 cases).
- Higher hospital volume demonstrated reduced inpatient mortality (aOR 0.98 per 10 cases) and improved outcomes (aOR 1.02 per 10 cases).
- Increasing ST case volumes at both proceduralist and hospital levels were associated with better patient outcomes.
Conclusions:
- Elevated proceduralist and hospital ST case volumes are associated with decreased inpatient mortality and enhanced patient outcomes.
- These findings provide evidence supporting volume-based guidelines for ST training and certification.
- Optimizing ST care may involve establishing minimum case volume requirements.
Background And Purpose:
Despite the Joint Commission’s certification requirement of ≥15 stroke thrombectomy (ST) cases per center and proceduralist annually, the relationship between ST case volumes and outcomes is uncertain. We sought to determine whether a proceduralist or hospital volume threshold exists that is associated with better outcomes among Medicare beneficiaries.
Methods:
Retrospective cohort study using validated International Classification of Diseases, Tenth Revision, Clinical Modification codes to identify admissions with acute ischemic stroke and treatment with ST. We used de-identified, national 100% inpatient Medicare data sets from January 1, 2016, to December 31, 2017 for US individuals aged ≥65 years. We calculated total procedures by proceduralist and hospital. We performed adjusted logistic regression of total cases as a predictor of inpatient mortality, good outcome (defined by dichotomized discharge disposition of inpatient rehabilitation or better), and 30-day readmission. We adjusted for sex, age, Charlson Comorbidity Index, availability of neurocritical care, teaching hospital status, socioeconomic status, 2-year stroke volume, and urban versus rural hospital location. We dichotomized case numbers incrementally to determine a volume threshold for better outcomes.
Results:
Thirteen thousand three hundred thirty-five patients were treated with ST by 2754 proceduralists at 641 hospitals. For every 10 more proceduralist cases, patients had 4% lower adjusted odds of inpatient mortality (adjusted odds ratio, 0.96 [95% CI, 0.95–0.98], P<0.0001) and 3% greater adjusted odds of good outcome (adjusted odds ratio, 1.03 [95% CI, 1.02–1.04], P<0.0001). For every 10 more hospital cases, patients had 2% lower odds of inpatient mortality (adjusted odds ratio, 0.98 [95% CI, 0.98–0.99], P=0.0003) and 2% greater odds of good outcome (adjusted odds ratio, 1.02 [95% CI, 1.01–1.02], P<0.0001). With increasing volumes, there were higher odds of better outcomes.
Conclusions:
Nationally, higher proceduralist and hospital ST case volumes were associated with reduced inpatient mortality and better outcome. These data support volume requirements in guidelines for ST training and certification.
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