309157
Relationship between volume of carotid artery stenting procedures performed and short-term outcomes: A nationwide study in Taiwan
Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are two revascularization procedures used to treat carotid artery stenosis for the prevention of stroke. The comparative effectiveness of CAS versus CEA remains unclear; however, CAS is less invasive. Despite the considerable skill and experience required of those who perform CAS, its use is on the increase. In Taiwan, CAS was first covered by National Health Insurance in 2004. Nonetheless, the volume of CAS procedures being performed and the outcomes following the procedure have not been well documented.
Objectives:
To assess the relationship between healthcare provider volume and thirty-day risk of stroke or death following CAS in Taiwan between 2004 and 2010 using the National Health Insurance database.
Methods:
We conducted an observational study using the National Health Insurance Database in Taiwan, observing data regarding patients aged 20 years or older who were hospitalized for CAS from 2004 to 2010. The annual number of procedures conducted by providers was divided into high volume (>10), medium volume (5-10), low volume (1.8-5), and very low volume (<1.8). Thirty-day mortality and stroke occurrence following hospitalization were used as study outcomes.
Results:
A total of 3,138 patients underwent CAS and 522 providers performed the procedure during the period of study. The mean age was 72.12 years old approximately 81.2% were male. 316 (10.1%) patients experienced a stroke or died within the 30 days following the procedure. Following multivariate adjustment, it was found that the risk of stroke or death was higher among patients treated by providers with lower volume (OR=1.32 [95% CI, 0.90-1.93], OR=1.50 [95% CI, 1.03-2.18], OR=2.44 [95% CI, 1.73-3.45], p=.006), compared to providers with high annual volume (>10).
Conclusions:
Among patients undergoing CAS, healthcare providers with lower annual volume were associated with higher 30-days risk of stroke or death in Taiwan.
Learning Areas:
Chronic disease management and preventionPublic health or related research
Learning Objectives:
Assess the relationship between physician volume and perioperative outcome following carotid artery stenting using the National Health Insurance database.
Qualified on the content I am responsible for because: I'm a assistant professor in College of Public Health of National Taiwan University. I severed in Institute of Health Policy and Management and I devoted myself to Health Service and outcome research.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.