Influence of hospital capabilities and prehospital time on outcomes of thrombectomy for stroke in Japan from 2013 to 2016

Ai Kurogi; Daisuke Onozuka; Akihito Hagihara; Kunihiro Nishimura; Akiko Kada; Manabu Hasegawa; Takahiro Higashi; Takanari Kitazono; Tsuyoshi Ohta; Nobuyuki Sakai; Hajime Arai; Susumu Miyamoto; Tetsuya Sakamoto; Koji Iihara; J-ASPECT Study Collaborators

doi:10.1038/s41598-022-06074-1

Influence of hospital capabilities and prehospital time on outcomes of thrombectomy for stroke in Japan from 2013 to 2016

Sci Rep. 2022 Feb 28;12(1):3252. doi: 10.1038/s41598-022-06074-1.

Authors

Collaborators

J-ASPECT Study Collaborators:
Masayoshi Takigami, Kenji Kamiyama, Kiyohiro Houkin, Shogo Nishi, Sadao Kaneko, Koji Oka, Yusuke Nakagaki, Hiroshi Ooyama, Katsumi Takizawa, Naoki Tokumitsu, Susumu Suzuki, Nozomi Suzuki, Teruo Kimura, Naoto Izumi, Kazumi Nitta, Masafumi Ohtaki, Masanori Isobe, Mikio Nishiya, Mitsunobu Kaijima, Syouji Mabuchi, Kuniaki Ogasawara, Naohiko Kubo, Yukihiko Shimizu, Keiichi Saito, Tatumi Yamanome, Akinori Yabuta, Atsuo Yoshino, Junichi Harashina, Masami Shimoda, Hiroyuki Jimbo, Hideki Murakami, Hiroyuki Masaoka, Hirotoshi Ohtaka, Hiroki Yoshida, Ichiro Suzuki, Michihiro Kohno, Yoshinori Arai, Akira Isoshima, Mitsuhiko Hokari, Kensuke Kawai, Taketoshi Maehara, Hajime Arai, Takakazu Kawamata, Makoto Noguchi, Haruhiko Hoshino, Hirofumi Hiyama, Kensaku Yoshida, Mitsuyuki Fujitsuka, Yasuaki Takeda, Hirohide Karasudani, Shiro Kobayashi, Michio Nakamura, Junichi Ono, Sumio Suda, Hiromu Hadeishi, Kenji Wakui, Hirokazu Tanno, Naoaki Sato, Hideki Sakai, Takashi Matsumoto, Naoki Koketsu, Ichiro Nakahara, Toshinori Hasegawa, Naoto Kuwayama, Nobuhiko Mizutani, Noriyuki Suzaki, Keizo Yasui, Akira Ikeda, Youtarou Takeuchi, Toshihiko Wakabayashi, Hisashi Tanaka, Junpei Yoshimoto, Ogura Koichiro, Toshio Yokoe, Kenichi Murao, Tomonori Yamada, Amami Kato, Akatsuki Wakayama, Hiroharu Kataoka, Kouich Iwatsuki, Yoshikazu Nakajima, Hidefuku Gi, Ryunosuke Uranishi, Yusaku Nakamura, Kazunori Yamanaka, Hiroyuki Matsumoto, Hiroaki Fujiwara, Yoshiyasu Iwai, Masashi Morikawa, Kazuyuki Tane, Kazuo Hashikawa, Shunichi Yoneda, Kohsuke Yamashita, Masahiko Kitano, Kazuhito Nakamura, Katsuhiko Kono, Kenji Ohata, Toshihiko Kuroiwa, Kazusige Maeno, Motohiro Arai, Masaaki Iwase, Kenji Hashimoto, Takashi Tsuruno, Shinichiro Kurokawa, Takeshi Matsuyama, Takamichi Yuguchi, Yoshihumi Teramoto, Takayuki Matsuo, Naoki Kitagawa, Makio Kaminogo, Seisaburo Sakamoto, Yoshiharu Tokunaga, Ei-Ichirou Urasaki, Junichi Kuratsu, Akira Takada, Shu Hasegawa, Toru Nishi, Isao Fuwa, Hiromasa Tsuiki, Hiromasa Tsuiki, Kazunari Koga, Hiroshi Egami, Tadao Kawamura, Makoto Goda, Yu Takeda, Yasuyuki Nagai, Masaki Morisige, Yutaka Yamaguchi, Shiro Miyata, Hideo Takeshima, Kazutaka Yatsushiro, Hajime Ohta, Kazuho Hirahara, Teruaki Kawano, Souichi Obara, Hiroshi Seto, Shunichi Tanaka, Koiti Moroki, Kazunori Arita, Shogo Ishiuchi, Toshimitsu Uchihara, Susumu Mekaru, Tomoaki Nagamine, Jin Momoji, Satoshi Yamamoto, Atusi Kimoto, Tsutomu Kadekaru, Akihiko Saito, Osamu Onodera, Hideaki Takahashi, Hiroyuki Arai, Shigekazu Takeuchi, Hiroki Takano, Osamu Fukuda, Mitsuo Kouno, Igarashi Michitoku, Michiya Kubo, Hiroaki Hondo, Miyamori Tadao, Ryouichi Masuda, Takata Hisashi, Toru Masuoka, Naoki Shirasaki, Hisashi Nitta, Makoto Kimura, Hisato Minamide, Shunsuke Shiraga, Mitsutoshi Nakada, Shuji Sato, Hiroki Toda, Osamu Yamamura, Masanori Kabuto, Jyunya Hayashi, Hiroyuki Kinouchi, Toyoaki Shinohara, Hidehito Koizumi, Mikito Uchida, Syougo Imae, Hiroshi Ozawa, Osamu Nishizaki, Masakazu Suga, Kanehisa Kohno, Kiichiro Zenke, Hiromichi Sadashima, Hikaru Mizobuchi, Satoru Hayashi, Masanori Morimoto, Takeshi Kohno, Tetsuya Ueba, Hiroyuki Nishimura, Norihito Shirakawa, Masahiro Kagawa, Naoki Hayashi, Atsushi Shindo, Kimihiro Yoshino, Tetsuya Masaoka, Kenwakai Otemati Hospital, Ichiro Nakahara, Akira Nakamizo, Yuji Okamoto, Shigenari Kin, Haruki Takahashi, Satoshi Suzuki, Koji Iihara, Katsuyuki Hirakawa, Akira Nakamizo, Akio Ookura, Koichirou Matsukado, Hidenori Yoshida, Hiroshi Nakane, Isao Inoue, Kei Hisada, Tsutomu Hitotsumatsu, Kouichi Kuramoto, Junya Hayashi, Hiromichi Ooishi, Masani Nonaka, Motohiro Morioka, Haruhisa Tsukamoto, Hiroshi Sugimori, Shinichirou Ishihara, Nobuaki Momozaki, Masayuki Miyazono, Akihiro Nemoto, Nobuo Hirota, Hiroaki Tanaka, Hiroshi Tanaka, Atsushi Tsuchiya, Katsumi Sakata, Hidetoshi Murata, Motohiro Nomura, Hitoshi Ozawa, Kotaro Tsumura, Makoto Inaba, Taturou Mori, Tomoaki Terada, Takahisa Mori, Masato Sugitani, Yuichiro Tanaka, Masaru Yamada, Mitsunori Matsumae, Keiichirou Onitsuka, Kosuke Miyahara, Sumio Endou, Atsuhiro Kojima, Shinichi Yagi, Hidekazu Takahashi, Hiroyuki Kaidu, Akira Tsunoda, Kyoichi Nomura, Takamitsu Fujimaki, Hidetoshi Ooigawa, Masahiko Tanaka, Hiroshi Wanihuchi, Hirochiyo Wada, Akio Hyodo, Ken Asakura, Akazi Kazunori, Hideyuki Kurihara, Shigehiro Ohmori, Hiroshi Kusunoki, Satoshi Magarisawa, Shinichi Okabe, Shinji Yamamoto, Hiroko Oyama, Shin Tsuruoka, Mikihiko Takeshita, Akira Matsumura, Kazuya Uemura, Hitoshi Tabata, Keishi Fujita, Masashi Nakatsukasa, Norifumi Shimoeda, Hideo Kunimine, Masayuki Ishihara, Kazuhiro Kikuchi, Nozomu Murai, Warou Taki, Nobukuni Murakami, Minoru Kidooka, Yoshihiro Iwamoto, Hiroshi Tenjin, Kouji Shiga, Nobuhito Mori, Eiji Kohmura, Takeshi Kondoh, Haruo Yamashita, Keigo Matsumoto, Naoya Takeda, Takayuki Sakaki, Hiroji Miyake, Eiichiro Mabuchi, Masayuki Yokota, No, Hideyuki Ohnishi, Masaaki Saiki, Minoru Asahi, Junji Koyama, Yoshio Sakagami, Shinya Noda, Junichi Iida, Tetsuya Morimoto, Hiroyuki Nakase, Hidehiro Hirabayashi, Naoyuki Nakao, Toshikazu Kuwata, Yoshinari Nakamura, Hiroshi Ishiguchi, Teruyuki Habu, Masamichi Kurosaki, Hiroki Ohkuma, Seiko Hasegawa, Hiromu Konno, Atsuhito Takemura, Atsuya Okubo, Hitoshi Saito, Junta Moroi, Hiroaki Shimizu, Masayuki Sasou, Yoichi Watanabe, Kiyoshi Saito, Masahiro Satoh, Zenichiro Watanabe, Takayuki Koizumi, Shoji Mashiyama, Tomoyoshi Oikawa, Sonoda Yukihiko, Rei Kondo, Atsuo Shinoda, Eiichiro Kamatsuka, Keiten So, Toshihiko Kinjo, Kennji Itou, Yohei Kudoh, Kazuhiko Sato, Arai Hiroaki, Hidenori Endo, Hiroshi Karibe, Kou Takahashi, Masayuki Nakajima, Kazuyoshi Watanabe, Kazuhiko Nozaki, Motohiro Takayama, Tarou Komuro, Fumio Suzuki, Hidenori Suzuki, Hiroto Murata, Fumitaka Miya, Seiji Fukazawa, Seiya Takehara, Yoshihiko Watanabe, Teiji Nakayama, Haruhiko Sato, Shinji Amano, Katsuhiro Kuroda, Akira Morooka, Takafumi Wataya, Tetsuya Tanigawara, Toru Iwama, Junki Ito, Shinji Noda, Kazuyuki Kouno, Kazuo Kitazawa, Yoshikazu Kusano, Masanobu Hokama, Hiroki Sato, Sumio Kobayashi, Shinsuke Muraoka, Masaki Miyatake, Kensuke Hayashida, Keiichi Sakai, Fusao Ikawa, Gen Ishida, Takato Kagawa, Youichirou Namba, Hiroyuki Nakashima, Koji Tokunaga, Isao Date, Masaaki Uno, Masaki Chin, Hidemichi Sasayama, Hideyuki Yoshida, Akira Watanabe, Kunihiko Harada, Manabu Urakawa, Yasuhiro Hamada, Michiyasu Suzuki, Takafumi Nishizaki, Katsuhiro Yamashita, Ryuji Nakamura, Masayuki Sumida, Shinichi Wakabayashi, Kaoru Kurisu, Atsushi Tominaga, Masaaki Shibukawa, Kawamoto Yukihiko, Shinji Okita, Kenjirou Hujiwara, Takashi Matsuoka, Osamu Hamasaki, Junichiro Satomi, Masahito Agawa, Hirofumi Oka, Kunikazu Yoshimura, Sei Haga, Katsuyuki Asaoka, Toshitaka Nakamura, Makoto Takeda, Nobuaki Kobayasi, Satoshi Ushikoshi, Nobuhiro Mikuni, Jun Niwa, Rokuya Tanikawa, Akinori Yamamura, Akira Takahashi, Noriaki Watabe, Junkoh Sasaki, Yasunari Otawara, Kazuyuki Miura, Teiji Tominaga, Tatsuya Sasaki, Takayuki Sugawara, Masayuki Ezura, Kenji Yamamoto, Syuichi Ishikawa, Yoshida Masahiro, Sunao Takemura, Masahisa Kawakami, Satoshi Ihara, Yasushi Shibata, Takashi Saegusa, Toshihiko Iuchi, Chiaki Ito, Seiichiro Hoshi, Sumio Isimaru, Osamu Okuda, Kazunari Yoshida, Takekazu Akiyama, Masateru Katayama, Masahiko Kasai, Tomonori Kobayashi, Oikawa Akihiro, Naohisa Miura, Osamu Tao, Takahiro Oota, Atumi Takenobu, Toshihiro Kumabe, Sachio Suzuki, Takashi Kumagai, Keiichi Nishimaki, Kazuhiro Hongo, Yasuyuki Toba, Kuroyanagi Takayuki, Hiroaki Shigeta, Atsushi Sato, Satoshi Kuroda, Cheho Park, Sotaro Higashi, Hirofumi Oyama, Kazuyoshi Hattori, Yoichi Uozumi, Norimoto Nakahara, Mitsuhito Mase, Nobukazu Hashimoto, Toshikazu Ichihashi, Katsunobu Takenaka, Shinichi Shirakami, Yoshinari Okumura, Kazuhiro Yokoyama, Susumu Miyamoto, Yoshinori Akiyama, Kenji Hashimoto, Masaaki Saiki, Kazuo Yamamoto, Naofumi Isono, Tsugumichi Ichioka, Nakazawa Kazutomo, Misao Nishikawa, Tsuyoshi Inoue, Manabu Kinoshita, Shinichi Yoshimura, Minoru Saitoh, Hideo Aihara, Hajimu Miyake, Kazuyuki Kuwayama, Kotaro Ogihara, Shigeki Nishino, Yasuyuki Miyoshi, Tadashi Arisawa, Shigeru Daido, Kimihisa Kinoshita, Keisuke Migita, Keiichi Akatsuka, Hirosuke Fujisawa, Junkoh Yamamoto, Yosimasa Kinosita, Satoshi Inoha, Hitonori Takaba, Tadahisa Shono, Hitoshi Tsugu, Shuji Hayashi, Tatsuya Abe, Susumu Nakashima, Takehisa Tuji, Keizou Yamamoto, Akihiko Kaga, Reizou Kanemaru, Koji Takasaki, Junichi Imamura, Masahiro Noha, Saburo Watanabe, Nobuyuki Sakai, Hiroaki Minami, Tomoyoshi Okumura, Shinjitsu Nishimura, Shinichi Numazawa, Yasunari Niimi, Isao Kitahara, Hidemitu Nakagawa, Kiyoshi Kazekawa, Kouzou Fukuyama, Makoto Ichinose, Koji Matuoka, Yasuhiro Fujimoto, Youichi Hashimoto, Takeshi Matsuoka, Takamitsu Uchizawa, Tomohiko Satou, Makoto Hasebe, Tomoaki Kameda, Hiroaki Sawaura, Takayuki Kubodera, Satoshi Utsuki, Kazuaki Awamori, Chiaki Takahashi, Kazumasa Yamatani, Toshiyuki Tsukada, Ryoichi Hayashi, Masakazu Kitahara, Yukinari Kakizawa, Yasumasa Yamamoto, Takashi Yoshida, Shinji Okumura, Yasunobu Gotou, Takashi Tominaga, Hirotoshi Hamaguchi, Nozomi Mori, Naoki Shinohara, Yasushi Ejima, Mayumi Mori, Hitoshi Miyake, Masaru Idei, Yoshihiro Nishiura, Hiromichi Koga, Kazuya Morimoto, Jae-Hyun Son, Yoshimasa Niiya, Tsuneo Shishido, Mamoru Murakami, Takaaki Yoshida, Masahito Hara, Tatsuya Nakamura, Takuya Kawai, Takashi Inoue, Isao Sasaki, Katsuhiko Hayashi, Ichiro Fujishima, Naoko Fujimura, Seiko Kataoka, Masayuki Yokota

Affiliations

¹ Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
² Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Japan.
³ Department of Clinical Research Planning and Management, Clinical Research Center, National Hospital Organization Nagoya Medical Centre, Nagoya, Japan.
⁴ Immunization Office, Health Service Division, Health Service Bureau, Ministry of Health, Labor and Welfare, Tokyo, Japan.
⁵ Division of Health Services Research, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan.
⁶ Department of Medicine and Clinical Science, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan.
⁷ Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan.
⁸ Department of Neurosurgery, Kobe City Medical Centre General Hospital, Kobe, Japan.
⁹ Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan.
¹⁰ Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
¹¹ Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan.
¹² Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. kiihara@ncvc.go.jp.
¹³ Department of Neurosurgery, Director General of the Hospital, National Cerebral and Cardiovascular Center, 6-1, Kishibe-shimmmachi, Suita, Osaka, 564-8565, Japan. kiihara@ncvc.go.jp.

Abstract

To determine whether increasing thrombectomy-capable hospitals with moderate comprehensive stroke center (CSC) capabilities is a valid alternative to centralization of those with high CSC capabilities. This retrospective, nationwide, observational study used data from the J-ASPECT database linked to national emergency medical service (EMS) records, captured during 2013-2016. We compared the influence of mechanical thrombectomy (MT) use, the CSC score, and the total EMS response time on the modified Rankin Scale score at discharge among patients with acute ischemic stroke transported by ambulance, in phases I (2013-2014, 1461 patients) and II (2015-2016, 3259 patients). We used ordinal logistic regression analyses to analyze outcomes. From phase I to II, MTs increased from 2.7 to 5.5%, and full-time endovascular physicians per hospital decreased. The CSC score and EMS response time remained unchanged. In phase I, higher CSC scores were associated with better outcomes (1-point increase, odds ratio [95% confidence interval]: 0.951 [0.915-0.989]) and longer EMS response time was associated with worse outcomes (1-min increase, 1.007 [1.001-1.013]). In phase II, neither influenced the outcomes. During the transitional shortage of thrombectomy-capable hospitals, increasing hospitals with moderate CSC scores may increase nationwide access to MT, improving outcomes.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Brain Ischemia*
Emergency Medical Services*
Hospitals
Humans
Ischemic Stroke*
Japan
Retrospective Studies
Stroke* / surgery
Thrombectomy
Treatment Outcome