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J Crit Care. 2017 Feb;37:240-243. doi: 10.1016/j.jcrc.2016.09.009. Epub 2016 Sep 14.

Impact of hospital case-volume on subarachnoid hemorrhage outcomes: A nationwide analysis adjusting for hemorrhage severity.

Author information

1
Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia, Room 2438, Jim Pattison Pavilion, 2nd Floor, 855 W 12th Ave, Vancouver, British Columbia, Canada V5Z 1M9; Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Ave, Boston, MA 02115. Electronic address: bar890@mail.harvard.edu.
2
Department of Anesthesia, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: kaliromano@gmail.com.
3
Division of Epilepsy, Department of Neurology, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: ashkanani63@hotmail.com.
4
Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia, Room 2438, Jim Pattison Pavilion, 2nd Floor, 855 W 12th Ave, Vancouver, British Columbia, Canada V5Z 1M9; Department of Critical Care Medicine, Surrey Memorial Hospital, Surrey, BC, Canada. Electronic address: robmcdermid@telus.net.
5
Beth Israel Deaconess Medical Center, Boston, MA, USA. Electronic address: lceli@bidmc.harvard.edu.

Abstract

OBJECTIVE:

There have been suggestions that patients with subarachnoid hemorrhage (SAH) have a better outcome when treated in high-volume centers. Much of the published literature on the subject is limited by an inability to control for severity of SAH.

METHODS:

This is a nationwide retrospective cohort analysis using the Nationwide Inpatient Sample (NIS). The NIS Subarachnoid Severity Scale was used to adjust for severity of SAH in multivariate logistic regression modeling.

RESULTS:

The records of 47 911 414 hospital admissions from the 2006-2011 NIS samples were examined. There were 11 607 patients who met inclusion criteria for the study. Of these, 7787 (67.0%) were treated at a high-volume center compared with 3820 (32.9%) treated at a low-volume center. Patients treated at high-volume centers compared with low-volume centers were more likely to receive endovascular aneurysm control (58.5% vs 51.2%, P=.04), be transferred from another hospital (35.4% vs 19.7%, P<.01), be treated in a teaching facility (97.3% vs 72.9%, P<.01), and have a longer length of stay (14.9 days [interquartile range 10.3-21.7] vs 13.9 days [interquartile range, 8.9-20.1], P<.01). After adjustment for all baseline covariates, including severity of SAH, treatment in a high-volume center was associated with an odds ratio for death of 0.82 (95% confidence interval, 0.72-0.95; P<.01) and a higher odds of a good functional outcome (odds ratio, 1.16; 95% confidence interval, 1.04-1.28; P<.01).

CONCLUSION:

After adjustment for severity of SAH, treatment in a high-volume center was associated with a lower risk of in-hospital mortality and a higher odds of a good functional outcome.

KEYWORDS:

Case volume; Outcomes; Subarachnoid hemorrhage; United States

PMID:
27663296
PMCID:
PMC5679218
DOI:
10.1016/j.jcrc.2016.09.009
[Indexed for MEDLINE]
Free PMC Article

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