Between-Center Variation in Outcome After Endovascular
Treatment of Acute Stroke: Analysis of Two Nationwide
Registries

J 2022

Between-Center Variation in Outcome After Endovascular Treatment of Acute Stroke: Analysis of Two Nationwide Registries

JANSSEN, Paula M, Katrine van OVERHAGEN, Jan VINKLÁREK, Bob ROOZENBEEK, H Bart VAN DER WORP et. al.

Základní údaje

Originální název

Between-Center Variation in Outcome After Endovascular Treatment of Acute Stroke: Analysis of Two Nationwide Registries

Autoři

JANSSEN, Paula M (garant), Katrine van OVERHAGEN, Jan VINKLÁREK (203 Česká republika, domácí), Bob ROOZENBEEK, H Bart VAN DER WORP, Charles B. MAJOIE, Michal BAR, David ČERNÍK, Roman HERZIG, Lubomir JURÁK, Svatopluk OSTRÝ, Robert MIKULÍK (203 Česká republika, domácí), Hester F LINGSMA a Diederik W J DIPPEL

Vydání

Circulation: Cardiovascular Quality and Outcomes logo, PHILADELPHIA, LIPPINCOTT WILLIAMS & WILKINS, 2022, 1941-7705

Další údaje

Jazyk

angličtina

Typ výsledku

Článek v odborném periodiku

Obor

30201 Cardiac and Cardiovascular systems

Stát vydavatele

Spojené státy

Utajení

není předmětem státního či obchodního tajemství

Odkazy

URL

Impakt faktor

Impact factor: 6.900

Kód RIV

RIV/00216224:14110/22:00126930

Organizační jednotka

Lékařská fakulta

DOI

http://dx.doi.org/10.1161/CIRCOUTCOMES.121.008180

UT WoS

000767469300005

Klíčová slova anglicky

icenter study; thrombectomy; stroke; hospitals; quality improvement

Štítky

14110127, rivok

Příznaky

Mezinárodní význam, Recenzováno

Změněno: 5. 4. 2023 13:49, Mgr. Tereza Miškechová

Anotace

V originále

Background: Insight in differences in patient outcomes between endovascular thrombectomy (EVT) centers can help to improve stroke care. We assessed between-center variation in functional outcome of patients with acute ischemic stroke who were treated with EVT. We analyzed to what extent this variation may be explained by modifiable center characteristics. Methods: We used nationwide registry data of patients with stroke treated with EVT in the Netherlands and in the Czech Republic. Primary outcome was modified Rankin Scale score at 90 days as an indicator of disability. We used multilevel ordinal logistic regression to quantify the between-center variation in outcomes and the impact of patient and center characteristics. Between-center variation was expressed as the relative difference in odds of a more favorable modified Rankin Scale score between a relatively better performing center (75th percentile) and a relatively worse performing center (25th percentile). Results: We included a total of 4518 patients treated in 33 centers. Adjusted for patient characteristics, the odds of a more favorable outcome in a center at the 75th percentile of the outcome distribution were 1.46 times higher (95% CI, 1.31-1.70) than the odds in a center at the 25th percentile. Adjustment for center characteristics, including the median time between stroke onset and reperfusion per center, decreased this relative difference in odds to 1.30 (95% CI, 1.18-1.50, P=0.01). This translates into an absolute difference in likelihood of good functional outcome of 8% after adjustment for patient characteristics and to 5% after further adjustment for modifiable center characteristics. Conclusions: The considerable between-center variation in patient outcomes after EVT for acute ischemic stroke could be largely explained by center-specific characteristics, such as time to reperfusion. Improvement of these parameters may likely result in a decrease in center-specific differences, and an overall improvement in outcome of patients with acute ischemic stroke.

Návaznosti

90128, velká výzkumná infrastruktura

Název: CZECRIN III

Citovat

JANSSEN, Paula M, Katrine van OVERHAGEN, Jan VINKLÁREK, Bob ROOZENBEEK, H Bart VAN DER WORP, Charles B. MAJOIE, Michal BAR, David ČERNÍK, Roman HERZIG, Lubomir JURÁK, Svatopluk OSTRÝ, Robert MIKULÍK, Hester F LINGSMA a Diederik W J DIPPEL. Between-Center Variation in Outcome After Endovascular Treatment of Acute Stroke: Analysis of Two Nationwide Registries. Circulation: Cardiovascular Quality and Outcomes logo. PHILADELPHIA: LIPPINCOTT WILLIAMS & WILKINS, 2022, roč. 15, č. 3, s. 1-10. ISSN 1941-7705. Dostupné z: https://dx.doi.org/10.1161/CIRCOUTCOMES.121.008180.

@article{2225477,
   author = {Janssen, Paula M and Overhagen, Katrine van and Vinklárek, Jan and Roozenbeek, Bob and van der Worp, H Bart and Majoie, Charles B. and Bar, Michal and Černík, David and Herzig, Roman and Jurák, Lubomir and Ostrý, Svatopluk and Mikulík, Robert and Lingsma, Hester F and Dippel, Diederik W J},
   article_location = {PHILADELPHIA},
   article_number = {3},
   doi = {http://dx.doi.org/10.1161/CIRCOUTCOMES.121.008180},
   keywords = {icenter study; thrombectomy; stroke; hospitals; quality improvement},
   language = {eng},
   issn = {1941-7705},
   journal = {Circulation: Cardiovascular Quality and Outcomes logo},
   title = {Between-Center Variation in Outcome After Endovascular Treatment of Acute Stroke: Analysis of Two Nationwide Registries},
   url = {https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.121.008180},
   volume = {15},
   year = {2022}
}

TY  - JOUR
ID  - 2225477
AU  - Janssen, Paula M - Overhagen, Katrine van - Vinklárek, Jan - Roozenbeek, Bob - van der Worp, H Bart - Majoie, Charles B. - Bar, Michal - Černík, David - Herzig, Roman - Jurák, Lubomir - Ostrý, Svatopluk - Mikulík, Robert - Lingsma, Hester F - Dippel, Diederik W J
PY  - 2022
TI  - Between-Center Variation in Outcome After Endovascular Treatment of Acute Stroke: Analysis of Two Nationwide Registries
JF  - Circulation: Cardiovascular Quality and Outcomes logo
VL  - 15
IS  - 3
SP  - 1-10
EP  - 1-10
PB  - LIPPINCOTT WILLIAMS & WILKINS
SN  - 19417705
KW  - icenter study
KW  - thrombectomy
KW  - stroke
KW  - hospitals
KW  - quality improvement
UR  - https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.121.008180
N2  - Background: Insight in differences in patient outcomes between endovascular thrombectomy (EVT) centers can help to improve stroke care. We assessed between-center variation in functional outcome of patients with acute ischemic stroke who were treated with EVT. We analyzed to what extent this variation may be explained by modifiable center characteristics. Methods: We used nationwide registry data of patients with stroke treated with EVT in the Netherlands and in the Czech Republic. Primary outcome was modified Rankin Scale score at 90 days as an indicator of disability. We used multilevel ordinal logistic regression to quantify the between-center variation in outcomes and the impact of patient and center characteristics. Between-center variation was expressed as the relative difference in odds of a more favorable modified Rankin Scale score between a relatively better performing center (75th percentile) and a relatively worse performing center (25th percentile). Results: We included a total of 4518 patients treated in 33 centers. Adjusted for patient characteristics, the odds of a more favorable outcome in a center at the 75th percentile of the outcome distribution were 1.46 times higher (95% CI, 1.31-1.70) than the odds in a center at the 25th percentile. Adjustment for center characteristics, including the median time between stroke onset and reperfusion per center, decreased this relative difference in odds to 1.30 (95% CI, 1.18-1.50, P=0.01). This translates into an absolute difference in likelihood of good functional outcome of 8% after adjustment for patient characteristics and to 5% after further adjustment for modifiable center characteristics. Conclusions: The considerable between-center variation in patient outcomes after EVT for acute ischemic stroke could be largely explained by center-specific characteristics, such as time to reperfusion. Improvement of these parameters may likely result in a decrease in center-specific differences, and an overall improvement in outcome of patients with acute ischemic stroke.
ER  -

JANSSEN, Paula M, Katrine van OVERHAGEN, Jan VINKLÁREK, Bob ROOZENBEEK, H Bart VAN DER WORP, Charles B. MAJOIE, Michal BAR, David ČERNÍK, Roman HERZIG, Lubomir JURÁK, Svatopluk OSTRÝ, Robert MIKULÍK, Hester F LINGSMA a Diederik W J DIPPEL. Between-Center Variation in Outcome After Endovascular Treatment of Acute Stroke: Analysis of Two Nationwide Registries. \textit{Circulation: Cardiovascular Quality and Outcomes logo}. PHILADELPHIA: LIPPINCOTT WILLIAMS \&{} WILKINS, 2022, roč.~15, č.~3, s.~1-10. ISSN~1941-7705. Dostupné z: https://dx.doi.org/10.1161/CIRCOUTCOMES.121.008180.

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