Evidence map›Paper›PMID 30873551›Full record

ArticleNeurosurgery2020

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

Christian Lopez Ramos, Michael G Brandel, Robert C Rennert, Brian R Hirshman, Arvin R Wali, Jeffrey A Steinberg, David R Santiago-Dieppa, Mitchell Flagg, Scott E Olson, J Scott Pannell and 1 more

Abstract read
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In one paragraph

Article in Neurosurgery, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Carotid artery stenting for asymptomatic stenosis is associated with decreased 30-day readmission at very high volume centers.Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia · 2023
    Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

11 authors.

Christian Lopez RamosDepartment of Neurosurgery, University of California, San Diego, La Jolla, California.
Michael G BrandelDepartment of Neurosurgery, University of California, San Diego, La Jolla, California.
Robert C RennertDepartment of Neurosurgery, University of California, San Diego, La Jolla, California.
Brian R HirshmanDepartment of Neurosurgery, University of California, San Diego, La Jolla, California.
Arvin R WaliDepartment of Neurosurgery, University of California, San Diego, La Jolla, California.
Jeffrey A SteinbergDepartment of Neurosurgery, University of California, San Diego, La Jolla, California.
David R Santiago-DieppaDepartment of Neurosurgery, University of California, San Diego, La Jolla, California.
Mitchell FlaggDepartment of Neurosurgery, University of California, San Diego, La Jolla, California.
Scott E OlsonDepartment of Neurosurgery, University of California, San Diego, La Jolla, California.
J Scott PannellDepartment of Neurosurgery, University of California, San Diego, La Jolla, California.
Alexander A KhalessiDepartment of Neurosurgery, University of California, San Diego, La Jolla, California.

Funding

UC San Diego Clinical and Translational Research InstituteTL1TR001443 · NCATS · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI DEPP, COLIN A. · 2015 to 2019
$3.4M
NCATS NIH HHS TL1 TR001443
6 · The paper itself

Abstract

backgroundThe "Volume Pledge" aims to centralize carotid artery stenting (CAS) to hospitals and surgeons performing ≥10 and ≥5 procedures annually, respectively.

objectiveTo compare outcomes after CAS between hospitals and surgeons meeting or not meeting the Volume Pledge thresholds.

methodsWe 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.

resultsBetween 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).

conclusionMost 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.

Indexed as

AgedCarotid ArteriesCarotid Artery DiseasesEndarterectomy, CarotidFemaleHospital MortalityHospitals, High-VolumeHumansMaleMiddle AgedRetrospective StudiesStentsSurgeonsCarotid artery stentingCentralizationHealth policyHospital volumeOutcomesSurgeon volume

Identifiers

PMID30873551
PMCPMC7308658

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.