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High Subarachnoid Hemorrhage Patient Volume Associated With Lower Mortality and Better Outcomes

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High Subarachnoid Hemorrhage Patient Volume Associated With Lower Mortality and Better Outcomes NEUROSURGERY Pandey, A. S., Gemmete, J. J., Wilson, T. J., Chaudhary, N., Thompson, B. G., Morgenstern, L. B., Burke, J. F. 2015; 77 (3): 462-470

Abstract

High-volume centers have better outcomes than low-volume centers when managing complex conditions including subarachnoid hemorrhage (SAH).To quantify SAH volume-outcome association and determine the extent to which this association is influenced by aggressiveness of care.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.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.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.

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