According to new research led by the University of Missouri School of Medicine (Columbia, USA), the number of mechanical thrombectomies performed at a hospital is not an accurate indicator of patient outcomes. Using data from nearly 1,000 centres, researchers found that patients undergoing thrombectomies at smaller, rural hospitals did not have less favourable outcomes—in terms of functional independence rates—than patients treated in large healthcare systems.
These small hospitals conduct fewer than 15 thrombectomy procedures per year, which is less than the number required to obtain certain stroke centre certifications. Considering these new data, study author Adnan Qureshi (University of Missouri Health Care, Columbia, USA) stated that it is important to re-evaluate the relationship between numbers of procedures and patient outcomes.
“There is an increasing recognition that a large number of patients who could benefit from a thrombectomy are not receiving it,” Qureshi said. “Increasing the role of smaller hospitals and centres may be the key to increasing availability.”
It is hoped that expanding access would mean stroke patients who live hours away from comprehensive stroke care can still receive a thrombectomy at their local hospital—and any other care they need.
“One way we could increase the role of smaller hospitals is to provide travelling physicians who know how to perform a thrombectomy,” Qureshi added. “Other ways include updating their infrastructure and resources.”
In the present study, researchers also found that larger hospitals with a higher volume of mechanical thrombectomy procedures saw more adverse outcomes in stroke patients—such as death or permanent disability—as compared to smaller hospitals.
“There are several potential explanations for this,” Qureshi continued. “Hospitals that perform more thrombectomies also tend to see patients with a higher stroke severity, or those who are at higher risk because of another illness or condition. Smaller hospitals may not have the resources to treat these patients.”
According to Qureshi, another factor may be that larger hospitals are more likely to see more complex patients, so the chance of adverse outcomes or permanent disability occurring is higher.
Nevertheless, the data suggest that, overall, the number of thrombectomy procedures is not an accurate indicator of quality of care, and other factors like illness severity should be considered in certification processes. The authors describe this as indicating a “paradoxical relationship” between adverse outcomes and annual procedural volume of mechanical thrombectomies.
The study in question—now published in the journal Interventional Neuroradiology—was also co-authored by University of Missouri Health Care researchers Camilo Gomez and Farhan Siddiq. Additional authors include Hamza Maqsood (University of Tennessee Health Science Center, Chattanooga, USA), Daniel Ford, Daniel Hanley (both Johns Hopkins University School of Medicine, Baltimore, USA), Ameer Hassan (University of Texas Rio Grande Valley, Harlingen, USA), Chun Shing Kwok (Mid Cheshire Hospitals NHS Foundation Trust, Crewe, UK), Thanh N Nguyen (Boston University School of Medicine, Boston, USA), Alejandro Spiotta (Medical University of South Carolina, Charleston, USA) and Syed Zaidi (University of Toledo, Toledo, USA).
