Assessing the volume-outcome relationship of carotid artery stenting in nationwide administrative data: a challenge of patient population bias

Authors

Stefan W. Koester, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Tyler S. Cole, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Anna R. Kimata, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
Kevin L. Ma, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
Dimitri Benner, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Joshua S. Catapano, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Kavelin Rumalla, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
Michael T. Lawton, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Andrew F. Ducruet, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Felipe C. Albuquerque, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA Felipe.Albuquerque@barrowbrainandspine.com.Follow

Document Type

Article

Abstract

BACKGROUND: Studies have shown an association between surgical treatment volume and improved quality metrics. This study evaluated nationwide results in carotid artery stenting (CAS) procedural readmission rates, costs, and length of stay based on hospital treatment volume. METHODS: We used the Nationwide Readmissions Database for carotid stenosis from 2010 to 2015. Patients receiving CAS were matched based on demographics, illness severity, and relevant comorbidities. Patients were matched 1:1 between low- and high-volume centers using a non-parametric preprocessing matching program to adjust for parametric causal inferences. Nearest-neighbor propensity score matching was performed using logit distance. RESULTS: Low- and high-volume centers admitted a mean (SD) of 4.68 (3.79) and 25.10 (16.86) patients undergoing CAS per hospital, respectively. Comorbidities were significantly different and initially could not be adequately matched. Because of significant differences in baseline patient population characteristics after attempted matching between low- and high-volume centers, we used propensity adjustment with multivariate analysis. Using this alternative approach, no significant differences were observed between low- and high-volume centers for the presence of any complication, postoperative stroke, postoperative myocardial infarction, and readmission at 30 days. CONCLUSION: In 1:1 nearest-neighbor matching with a high number of patients, our analysis did not result in well-matched cohorts for the effect of case volume on outcomes. Comparing analytical techniques for various outcomes highlights that outcome disparities may not be related to quality differences based on hospital size, but rather variability in patient populations between low- and high-volume institutions.

Keywords

Statistics, Stenosis, Stent, Stroke

Publication Date

12-20-2022

Publication Title

Journal of neurointerventional surgery

E-ISSN

1759-8486

PubMed ID

36539274

Digital Object Identifier (DOI)

10.1136/jnis-2022-019695

Recommended Citation

Koester, Stefan W.; Cole, Tyler S.; Kimata, Anna R.; Ma, Kevin L.; Benner, Dimitri; Catapano, Joshua S.; Rumalla, Kavelin; Lawton, Michael T.; Ducruet, Andrew F.; and Albuquerque, Felipe C., "Assessing the volume-outcome relationship of carotid artery stenting in nationwide administrative data: a challenge of patient population bias" (2022). Translational Neuroscience. 2236.
https://scholar.barrowneuro.org/neurobiology/2236