Tiffany R Chang1, Robert G Kowalski2, J Ricardo Carhuapoma3, Rafael J Tamargo4, Neeraj S Naval5. 1. Departments of Neurosurgery and Neurology, University of Texas Medical School, Houston, TX. Electronic address: Tiffany.R.Chang@uth.tmc.edu. 2. Anesthesia Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: rkowalski@gmail.com. 3. Anesthesia Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: jcarhua1@jhmi.edu. 4. Anesthesia Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: rtamarg@jhmi.edu. 5. Anesthesia Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: nnaval1@jhmi.edu.
Abstract
PURPOSE: To compare aneurysmal subarachnoid hemorrhage (aSAH) outcomes between high- and low-volume referral centers with dedicated neurosciences critical care units (NCCUs) and shared neurosurgical, endovascular, and neurocritical care practitioners. MATERIALS AND METHODS: Prospectively collected data of aSAH patients admitted to 2 institutional NCCUs were reviewed. NCCU A is a 22-bed unit staffed 24/7 with overnight in-house NCCU fellow and resident coverage. NCCU B is a 14-bed unit with home call by NCCU attending/fellow and in-house residents. RESULTS: A total of 161 aSAH patients (27%) were admitted to NCCU B compared with 447 at NCCU A (73%). Among factors that independently impacted hospital mortality, there were no differences in baseline characteristics: mean age (A: 53.5 ± 14.1 years, B: 53.1 ± 13.6 years), poor grade Hunt and Hess (A: 28.2%, B: 26.7%), presence of multiple medical comorbidities (A: 28%, B: 31.1%), and associated cocaine use (A: 11.6%, B: 14.3%). There was no significant difference in hospital mortality (A: 17.9%, B: 18%), poor functional outcome (A: 30%, B: 25.4%), aneurysm rerupture (A: 2.8%, B: 2.4%), or delayed cerebral ischemia (A: 14.1%, B: 16.1%). CONCLUSIONS: The noninferior outcomes at the lower SAH volume center suggests that provider expertise, not patient volume, is critical to providing high-quality specialized care.
PURPOSE: To compare aneurysmal subarachnoid hemorrhage (aSAH) outcomes between high- and low-volume referral centers with dedicated neurosciences critical care units (NCCUs) and shared neurosurgical, endovascular, and neurocritical care practitioners. MATERIALS AND METHODS: Prospectively collected data of aSAH patients admitted to 2 institutional NCCUs were reviewed. NCCU A is a 22-bed unit staffed 24/7 with overnight in-house NCCU fellow and resident coverage. NCCU B is a 14-bed unit with home call by NCCU attending/fellow and in-house residents. RESULTS: A total of 161 aSAH patients (27%) were admitted to NCCU B compared with 447 at NCCU A (73%). Among factors that independently impacted hospital mortality, there were no differences in baseline characteristics: mean age (A: 53.5 ± 14.1 years, B: 53.1 ± 13.6 years), poor grade Hunt and Hess (A: 28.2%, B: 26.7%), presence of multiple medical comorbidities (A: 28%, B: 31.1%), and associated cocaine use (A: 11.6%, B: 14.3%). There was no significant difference in hospital mortality (A: 17.9%, B: 18%), poor functional outcome (A: 30%, B: 25.4%), aneurysm rerupture (A: 2.8%, B: 2.4%), or delayed cerebral ischemia (A: 14.1%, B: 16.1%). CONCLUSIONS: The noninferior outcomes at the lower SAH volume center suggests that provider expertise, not patient volume, is critical to providing high-quality specialized care.
Authors: Brian S Katz; Opeolu Adeoye; Heidi Sucharew; Joseph P Broderick; Jason McMullan; Pooja Khatri; Michael Widener; Kathleen S Alwell; Charles J Moomaw; Brett M Kissela; Matthew L Flaherty; Daniel Woo; Simona Ferioli; Jason Mackey; Sharyl Martini; Felipe De Los Rios la Rosa; Dawn O Kleindorfer Journal: Stroke Date: 2017-07-12 Impact factor: 7.914
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Authors: Ahmad Kh Alhaj; Waleed Yousef; Abdulrahman Alanezi; Mariam Almutawa; Salem Zaidan; Tarik M Alsheikh; Moussa Abdulghaffar; Tariq Al-Saadi; Luigi M Cavallo; Dragan Savic Journal: Surg Neurol Int Date: 2021-11-02