The Potential Impact of "Take the Volume Pledge" on Outcomes After Carotid Artery Stenting.

Autor:	Lopez Ramos C; Department of Neurosurgery, University of California, San Diego, La Jolla, California., Brandel MG; Department of Neurosurgery, University of California, San Diego, La Jolla, California., Rennert RC; Department of Neurosurgery, University of California, San Diego, La Jolla, California., Hirshman BR; Department of Neurosurgery, University of California, San Diego, La Jolla, California., Wali AR; Department of Neurosurgery, University of California, San Diego, La Jolla, California., Steinberg JA; Department of Neurosurgery, University of California, San Diego, La Jolla, California., Santiago-Dieppa DR; Department of Neurosurgery, University of California, San Diego, La Jolla, California., Flagg M; Department of Neurosurgery, University of California, San Diego, La Jolla, California., Olson SE; Department of Neurosurgery, University of California, San Diego, La Jolla, California., Pannell JS; Department of Neurosurgery, University of California, San Diego, La Jolla, California., Khalessi AA; Department of Neurosurgery, University of California, San Diego, La Jolla, California.
Jazyk:	angličtina
Zdroj:	Neurosurgery [Neurosurgery] 2020 Feb 01; Vol. 86 (2), pp. 241-249.
DOI:	10.1093/neuros/nyz053
Abstrakt:	Background: The "Volume Pledge" aims to centralize carotid artery stenting (CAS) to hospitals and surgeons performing ≥10 and ≥5 procedures annually, respectively. Objective: To compare outcomes after CAS between hospitals and surgeons meeting or not meeting the Volume Pledge thresholds. Methods: We queried the Nationwide Inpatient Sample for CAS admissions. Hospitals and surgeons were categorized as low volume and high volume (HV) based on the Volume Pledge. Multivariable hierarchical regression models were used to examine the impact of hospital volume (2005-2011) and surgeon volume (2005-2009) on perioperative outcomes. Results: Between 2005 and 2011, 22 215 patients were identified. Most patients underwent CAS by HV hospitals (86.4%). No differences in poor outcome (composite endpoint of in-hospital mortality, postoperative neurological or cardiac complications) were observed by hospital volume but HV hospitals did decrease the likelihood of other complications, nonroutine discharge, and prolonged hospitalization. From 2005 to 2009, 9454 CAS admissions were associated with physician identifiers. Most patients received CAS by HV surgeons (79.2%). On multivariable analysis, hospital volume was not associated with improved outcomes but HV surgeons decreased odds of poor outcome (odds ratio [OR] 0.76, 95% confidence interval [CI] 0.59-0.97; P = .028), complications (OR 0.56, 95% CI 0.46-0.71, P < .001), nonroutine discharge (OR 0.70, 95% CI 0.57-0.87; P = .001), and prolonged hospitalization (OR 0.52, 95% 0.44-0.61, P < .001). Conclusion: Most patients receive CAS by hospitals and providers meeting the Volume Pledge threshold for CAS. Surgeons but not hospitals who met the policy's volume standards were associated with superior outcomes across all measured outcomes. (Copyright © 2019 by the Congress of Neurological Surgeons.)
Databáze:	MEDLINE
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