Objective:

To evaluate patient- and hospital-level characteristics of low-volume stroke thrombectomy (ST) centers.

Background:

Thrombectomy is an effective treatment for large vessel occlusion stroke but requires trained operators and a capable center. Although accreditation organizations have set minimum ST volume requirements for stroke center certification, low-volume ST centers could nevertheless play an important role in stroke systems of care. The characteristics of such centers are not well-known.

Design/Methods:

Using data from the Florida Healthcare Cost & Utilization Project and the American Hospital Association Annual Survey, we identified all hospitalizations of adult Florida residents in 2018-19 with a principal diagnosis of acute ischemic stroke who received ST. We stratified cases by whether the procedure was done at a center performing fewer than 15 ST procedures per year averaged over 2016-19. We compared the patient and hospital characteristics according to center volume and evaluated outcomes at discharge using a multivariate model.

Results:

Among 5814 patients treated with ST at 80 centers, 355 (6.1%) were treated at 37 low-volume ST centers. These patients were more often White and less often Black or Hispanic, were less likely to reside in low-income zip codes, and more frequently lived in metropolitan cores (p<0.001). Low-volume hospitals had lower bed counts and were less frequently teaching hospitals (p<0.001). The median (IQR) travel time to the nearest higher-volume center was 24.9 (12.4-33.6) minutes. In adjusted models, there were no differences in discharge outcomes (in-hospital mortality or hospice discharge: OR 0.87, 95% CI 0.59-1.28; not discharged home: OR 1.07, 95% CI 0.77-1.48) at low-volume versus higher-volume centers.

Conclusions:

Patients treated at low-volume ST centers in Florida were less often Black or Hispanic and less likely to live in low-income and ex-urban areas. Outcomes after ST were not discernibly different. These findings may indicate more stringent patient selection at low-volume centers but raise concern about access disparities.