1145 Higher Proceduralist Stroke Thrombectomy Volume is Associated With Reduced Inpatient Mortality

INTRODUCTION: In 2018, the JC and AHA introduced a new stroke care certification for Thrombectomy-Capable Stroke Centers, increasing both access and the number of proceduralists performing endovascular thrombectomies(EVT) nationwide. However, dispersing the overall volume for centers located in close proximity may have unclear effects on patient outcome. METHODS: We performed a retrospective cohort study using the 2020 Florida State Inpatient Database. We included adult patients who had a diagnosis of AIS and underwent EVT during the same admission. The primary study outcome was in-hospital death. We used Youden’s Index to define an optimal threshold for number of EVT/year/provider. Based on this cut-point, the cohort was dichotomized into low and high proceduralist volume groups. We fit logistic regression models to mortality in the full cohort, both as univariate analyses and after adjusting for covariates. RESULTS: Amongst 3,143 AIS patients who underwent EVT, 1,907 patients across 59 hospitals and 106 providers met our inclusion criteria. Amongst the 106 providers, the median (interquartile range) number of EVTs performed was 13.5 (7-25). The optimal cut-point was 17 EVT. Demographics and comorbidities were similar between the cohorts. Compared to the low volume cohort, the high volume cohort had a significantly lower rate of in-hospital mortality (low volume: 11.0%vs.high volume 7.2%, p=0.005). After adjusting for potential confounders, high proceduralist volume remained significantly associated with lower odds of in-hospital death(OR: 0.52, 95% CI 0.36 – 0.76, p<0.05). Between the two cohorts, the difference in absolute risk of death was approximately 4.8% (p <0.05). CONCLUSIONS: Our study found that high proceduralist volume, as defined by =18 EVT/year, was associated with reduced in-hospital morality. Further research is necessary to understand the effects of proceduralist experience and benchmarks for technical proficiency with the aim of improving the overall care of AIS patients.