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Effects of case volume and comprehensive stroke center capabilities on patient outcomes of clipping and coiling for subarachnoid hemorrhage
- Source :
- Journal of Neurosurgery. 134:929-939
- Publication Year :
- 2021
- Publisher :
- Journal of Neurosurgery Publishing Group (JNSPG), 2021.
-
Abstract
- OBJECTIVEImproved outcomes in patients with subarachnoid hemorrhage (SAH) treated at high-volume centers have been reported. The authors sought to examine whether hospital case volume and comprehensive stroke center (CSC) capabilities affect outcomes in patients treated with clipping or coiling for SAH.METHODSThe authors conducted a nationwide retrospective cohort study in 27,490 SAH patients who underwent clipping or coiling in 621 institutions between 2010 and 2015 and whose data were collected from the Japanese nationwide J-ASPECT Diagnosis Procedure Combination database. The CSC capabilities of each hospital were assessed by use of a validated scoring system based on answers to a previously reported 25-item questionnaire (CSC score 1–25 points). Hospitals were classified into quartiles based on CSC scores and case volumes of clipping or coiling for SAH.RESULTSOverall, the absolute risk reductions associated with high versus low case volumes and high versus low CSC scores were relatively small. Nevertheless, in patients who underwent clipping, a high case volume (> 14 cases/yr) was significantly associated with reduced in-hospital mortality (Q1 as control, Q4 OR 0.71, 95% CI 0.55–0.90) but not with short-term poor outcome. In patients who underwent coiling, a high case volume (> 9 cases/yr) was associated with reduced in-hospital mortality (Q4 OR 0.69, 95% CI 0.53–0.90) and short-term poor outcomes (Q3 [> 5 cases/yr] OR 0.75, 95% CI 0.59–0.96 vs Q4 OR 0.65, 95% CI 0.51–0.82). A high CSC score (> 19 points) was significantly associated with reduced in-hospital mortality for clipping (OR 0.68, 95% CI 0.54–0.86) but not coiling treatment. There was no association between CSC capabilities and short-term poor outcomes.CONCLUSIONSThe effects of case volume and CSC capabilities on in-hospital mortality and short-term functional outcomes in SAH patients differed between patients undergoing clipping and those undergoing coiling. In the modern endovascular era, better outcomes of clipping may be achieved in facilities with high CSC capabilities.
- Subjects :
- Adult
Male
medicine.medical_specialty
Subarachnoid hemorrhage
Databases, Factual
Aneurysm, Ruptured
Neurosurgical Procedures
Cohort Studies
03 medical and health sciences
0302 clinical medicine
Japan
Surveys and Questionnaires
medicine
Humans
In patient
Hospital Mortality
Stroke
Aged
Retrospective Studies
Clipping (audio)
Case volume
business.industry
Absolute risk reduction
Retrospective cohort study
General Medicine
Middle Aged
Subarachnoid Hemorrhage
Surgical Instruments
medicine.disease
Surgery
Treatment Outcome
Quartile
030220 oncology & carcinogenesis
Female
business
Risk Reduction Behavior
Hospitals, High-Volume
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 19330693 and 00223085
- Volume :
- 134
- Database :
- OpenAIRE
- Journal :
- Journal of Neurosurgery
- Accession number :
- edsair.doi.dedup.....907847c3d8e7004063a587ab3ccd8524