BACKGROUND: High-volume centers have better outcomes than low-volume centers when managing complex conditions including subarachnoid hemorrhage (SAH). OBJECTIVE: To quantify SAH volume-outcome association and determine the extent to which this association is influenced by aggressiveness of care. METHODS: A serial cross-sectional retrospective study using the Nationwide Inpatient Sample for 2002 to 2010 was performed. Included were all adult (older than 18 years of age) discharged patients with a primary diagnosis of SAH admitted from the emergency department or transferred to a discharging hospital; cases of trauma or arteriovenous malformation were excluded. Survey-weighted descriptive statistics estimated temporal trends. Multilevel logistic regression estimated volume-outcome associations for inpatient mortality and discharge home. Models were adjusted for demographic characteristics, year, transfer status, insurance status, all individual Charlson comorbidities, intubation, and all patient-refined, diagnosis-related group mortality. Analyses were repeated, excluding cases in which aggressive care was not pursued. RESULTS: A total of 32,336 discharges were included; 13,398 patients underwent clipping (59.1%) or coiling (40.9%). The inpatient mortality rate decreased from 32.2% in 2002 to 22.2% in 2010; discharge home increased from 28.5% to 40.8% during the same period. As SAH volume decreased from 100/year, the mortality rate increased from 18.7% to 19.8% at 80/year, 21.7% at 60/year, 24.5% at 40/year, and 28.4% at 20/year. As SAH patient volume decreased, the probability of discharge home decreased from 40.3% at 100/year to 38.7% at 60/year, and 35.3% at 20/year. Better outcomes persisted in patients receiving aggressive care and in those not receiving aggressive care. CONCLUSION: Short-term SAH outcomes have improved. High-volume hospitals have more favorable outcomes than low-volume hospitals. This effect is substantial, even for hospitals conventionally classified as high volume.
BACKGROUND: High-volume centers have better outcomes than low-volume centers when managing complex conditions including subarachnoid hemorrhage (SAH). OBJECTIVE: To quantify SAH volume-outcome association and determine the extent to which this association is influenced by aggressiveness of care. METHODS: A serial cross-sectional retrospective study using the Nationwide Inpatient Sample for 2002 to 2010 was performed. Included were all adult (older than 18 years of age) discharged patients with a primary diagnosis of SAH admitted from the emergency department or transferred to a discharging hospital; cases of trauma or arteriovenous malformation were excluded. Survey-weighted descriptive statistics estimated temporal trends. Multilevel logistic regression estimated volume-outcome associations for inpatient mortality and discharge home. Models were adjusted for demographic characteristics, year, transfer status, insurance status, all individual Charlson comorbidities, intubation, and all patient-refined, diagnosis-related group mortality. Analyses were repeated, excluding cases in which aggressive care was not pursued. RESULTS: A total of 32,336 discharges were included; 13,398 patients underwent clipping (59.1%) or coiling (40.9%). The inpatient mortality rate decreased from 32.2% in 2002 to 22.2% in 2010; discharge home increased from 28.5% to 40.8% during the same period. As SAH volume decreased from 100/year, the mortality rate increased from 18.7% to 19.8% at 80/year, 21.7% at 60/year, 24.5% at 40/year, and 28.4% at 20/year. As SAHpatient volume decreased, the probability of discharge home decreased from 40.3% at 100/year to 38.7% at 60/year, and 35.3% at 20/year. Better outcomes persisted in patients receiving aggressive care and in those not receiving aggressive care. CONCLUSION: Short-term SAH outcomes have improved. High-volume hospitals have more favorable outcomes than low-volume hospitals. This effect is substantial, even for hospitals conventionally classified as high volume.
Authors: Uma V Mahajan; Hammad A Khan; Xiaofei Zhou; Shaarada Srivatsa; Christina H Wright; Adam H Bates; Martha Sajatovic; Nicholas C Bambakidis Journal: Neurocrit Care Date: 2022-09-16 Impact factor: 3.532
Authors: Vishank A Shah; Syed Omar Kazmi; Rahul Damani; Alyssa Hartsell Harris; Samuel F Hohmann; Eusebia Calvillo; Jose I Suarez Journal: Front Neurol Date: 2022-06-16 Impact factor: 4.086
Authors: Alexander Hammer; Gholamreza Ranaie; Eduard Yakubov; Frank Erbguth; Markus Holtmannspoetter; Hans-Herbert Steiner; Hendrik Janssen Journal: Aging (Albany NY) Date: 2020-04-20 Impact factor: 5.682
Authors: Kori S Zachrison; Margaret E Samuels-Kalow; Sijia Li; Zhiyu Yan; Mathew J Reeves; Renee Y Hsia; Lee H Schwamm; Carlos A Camargo Journal: J Am Coll Emerg Physicians Open Date: 2022-03-14
Authors: Hai Sun; Piyush Kalakoti; Kanika Sharma; Jai Deep Thakur; Rimal H Dossani; Devi Prasad Patra; Kevin Phan; Hesam Akbarian-Tefaghi; Frank Farokhi; Christina Notarianni; Bharat Guthikonda; Anil Nanda Journal: PLoS One Date: 2017-10-27 Impact factor: 3.240