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Mechanical thrombectomy reduces the gap in treatment outcomes of ischemic stroke between hospital levels of care: analysis of a Korean nationwide data

Authors
 Kwon-Duk Seo  ;  Min Jin Kang  ;  Jae Kwang Lee  ;  Sang Hyun Suh  ;  Kyung-Yul Lee 
Citation
 ANNALS OF TRANSLATIONAL MEDICINE, Vol.9(15) : 1227, 2021-08 
Journal Title
ANNALS OF TRANSLATIONAL MEDICINE
ISSN
 2305-5847 
Issue Date
2021-08
Keywords
Thrombectomy ; mortality ; disability ; population health ; tertiary hospitals
Abstract
Background: Mechanical thrombectomy (MT) of ischemic stroke was demonstrated to be effective in clinical trials and was reported to have favorable outcomes in real clinical settings since 2015. We aimed to determine the national trends of MT and compare the outcomes between the different levels of treating hospital. Methods: We obtained data from the nationwide database from 2008 to 2017. Patients with ischemic stroke who received MT were identified using the International Classification of Disease Codes. Good outcome was defined as discharge to home, and a poor outcome was defined as cerebral hemorrhage, physical disability, or death. The study period was divided into three (off-label MT, transitional, MT period). Hospital groups where MT was performed were divided into tertiary and non-tertiary hospitals. Results: In MT period, 47.0% of the MT procedures were performed in non-tertiary hospitals compared with 36.1% in off-label MT period. Comparison of the 3-month mortality between patients who were treated in tertiary vs. non-tertiary hospitals revealed significant lower mortality in tertiary hospital through all period. The incidence of cerebral hemorrhage and physical disability did not differ between hospital groups. However, the percentage of patients discharged home was 41.4% for tertiary hospitals and 42.4% for non-tertiary hospitals, which was not statistically different in MT period (P=0.4671). Conclusions: Analysis of the nationwide data confirmed that the extent of increase in MT was higher in non-tertiary hospitals than tertiary hospitals. In addition, no significant difference was revealed in the number of favorable clinical outcome between the hospital groups during MT period.
Files in This Item:
T202103646.pdf Download
DOI
10.21037/atm-21-2342
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Suh, Sang Hyun(서상현) ORCID logo https://orcid.org/0000-0002-7098-4901
Lee, Kyung Yul(이경열) ORCID logo https://orcid.org/0000-0001-5585-7739
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/184769
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