Regional disparities and hospital performance patterns in acute stroke reperfusion: a multicenter study in Sichuan Province, China

Introduction Timely reperfusion is critical to improving outcomes in acute ischemic stroke (AIS). However, disparities in treatment quality and accessibility persist across hospital levels, regions, and organizational types in China. This study assessed real-world performance of reperfusion care in Sichuan Province. Methods We conducted a retrospective multicenter study across 33 hospitals in Chengdu from 2021 to 2024. Key process and outcome indicators—including door-to-needle time (DNT), door-to-puncture time (DPT), puncture-to-recanalization time (PRT), intravenous thrombolysis (IVT) within 4.5 h, endovascular treatment (EVT) within 6 h, and in-hospital mortality after EVT—were compared across hospital grades, geographic locations, and stroke center status. K-means clustering was used to explore hospital-level performance patterns based on reperfusion indicators. Results Door-to-needle time and IVT rates remained relatively high and stable. In contrast, PRT compliance and EVT accessibility showed notable variation. Tertiary A-level hospitals, urban hospitals, and certified stroke centers were associated with higher observed performance in several indicators. EVT-related mortality showed a transient observed spike in non-tertiary A-level and non-stroke center hospitals in 2023. Exploratory cluster analysis identified three hospital-level performance patterns, suggesting persistent disparities in capacity, access, and EVT-related in-hospital outcomes. Conclusion Our findings highlight institutional and regional inequities in AIS reperfusion care. Stroke center status was associated with higher observed efficiency, accessibility, and EVT-related in-hospital outcome indicators, although residual confounding cannot be excluded. To promote equitable, high-quality stroke care in western China, strategic investments are needed in infrastructure, workforce training, and networked stroke systems, particularly for non-tertiary A-level and non-stroke center hospitals.