title: Regional availability of mechanical embolectomy for acute ischemic stroke in California, 2009 to 2010.
abstract: OBJECTIVE
  We sought to assess the geographic proximity of patients with stroke in California to centers that performed specific threshold volumes of mechanical embolectomy procedures each year.
  
  
  METHODS
  We identified all patients who were hospitalized for acute ischemic stroke at all nonfederal acute care hospitals in California from 2009 to 2010, and all hospitals that performed any mechanical embolectomy procedures by case volume during the same period, using nonpublic data from the Office of Statewide Health Planning and Development. We computed geographic service areas around each hospital on the basis of prespecified ground transport distance thresholds. We then calculated the proportion of hospitalized patients with stroke who lived within service areas for centers that performed a low volume and high volume of mechanical embolectomy procedures each year.
  
  
  RESULTS
  During the 2-year study period, 15% (53/360) of hospitals performed at least 1 mechanical embolectomy for acute stroke, but only 19% (10/53) performed >10 cases per year. Most hospitalized patients with stroke (94%) lived within a 2-hour transport time (65 miles) to a hospital that performed ≥1 procedure during the 2-year period. Approximately 93% of the patients with stroke who received mechanical embolectomy lived within 20 miles from an embolectomy-capable hospital compared with 7% of those who lived >20 miles.
  
  
  CONCLUSIONS
  In California, most patients with stroke lived within reasonable ground transport distances from centers that performed ≥1 mechanical embolectomy in a 2-year period. The probability of receiving mechanical embolectomy for acute ischemic stroke was associated with living in close geographic proximity to these hospitals.
authors: From the Department of Neurology, Jeju National University, Jeju-do, South Korea (J.C.C); and Department of Emergency Medicine (R.Y.H.) and Neurology (A.S.K.), University of California, San Francisco.
authors: Jay Chol
authors: JC
authors: Choi
authors: From the Department of Neurology, Jeju National University, Jeju-do, South Korea (J.C.C); and Department of Emergency Medicine (R.Y.H.) and Neurology (A.S.K.), University of California, San Francisco.
authors: Renee Y
authors: RY
authors: Hsia
authors: From the Department of Neurology, Jeju National University, Jeju-do, South Korea (J.C.C); and Department of Emergency Medicine (R.Y.H.) and Neurology (A.S.K.), University of California, San Francisco. akim@ucsf.edu.
authors: Anthony S
authors: AS
authors: Kim
mesh_terms: D000368:Aged; D002140:California; D016208:Databases, Factual; D017128:Embolectomy / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D005843:Geography; D006297:Health Services Accessibility; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications* / Q000601:surgery*; D016896:Treatment Outcome
keywords: endovascular procedures; geographic location; stroke
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