Key result
Admission to high-volume hospitals for subarachnoid hemorrhage treated with clipping or coiling was associated with significantly lower 5-year mortality compared to low-volume hospitals (20.0% vs. 30.0%).
Why the study?
Recent improvements in devices, techniques, and neurocritical care have decreased subarachnoid hemorrhage mortality, but the relationship between hospital volume and short- and long-term mortality remained unclear.
Does treatment in high-volume hospitals reduce short- and long-term mortality in patients with subarachnoid hemorrhage compared to low-volume hospitals?
Cohort (n=625)
Yes
Does treatment in high-volume hospitals reduce short- and long-term mortality in patients with subarachnoid hemorrhage compared to low-volume hospitals?
Absolute Event Rate: 20% vs 30%
p-value: p=0.004
Treatment of acute subarachnoid hemorrhage in high-volume hospitals is associated with lower short- and long-term mortality compared to low-volume hospitals, especially for severe cases.
Supports high-volume care for severe subarachnoid hemorrhage; leaves open causality and generalizability.
BACKGROUND: Subarachnoid hemorrhage is a potentially devastating cerebrovascular attack with a high proportion of poor outcomes and mortality. Recent studies have reported decreased mortality with the improvement in devices and techniques for treating ruptured aneurysms and neurocritical care. This study investigated the relationship between hospital volume and short- and long-term mortality in patients treated with subarachnoid hemorrhage. METHODS: We selected subarachnoid hemorrhage patients treated with clipping and coiling from March-May 2013 to June-August 2014 using data from Acute Stroke Registry, and the selected subarachnoid hemorrhage (SAH) patients were tracked in connection with data of Health Insurance Review and Assessment Service to evaluate the short-term and long-term mortality. RESULTS: A total of 625 subarachnoid hemorrhage patients were admitted to high-volume hospitals (n = 355, 57%) and low-volume hospitals (n = 270, 43%) for six months. The mortality of SAH patients treated with clipping and coiling was 12.3%, 20.2%, 21.4%, and 24.3% at 14 days, three months, one year, and five years, respectively. The short-term and long-term mortality in high-volume hospitals was significantly lower than that in low-volume hospitals. On Cox regression analysis of death in patients with severe clinical status, low-volume hospitals had significantly higher mortality than high-volume hospitals during short-term follow-up. On Cox regression analysis in the mild clinical status group, there was no statistical difference between high-volume hospitals and low-volume hospitals. CONCLUSION: In subarachnoid hemorrhage patients treated with clipping and coiling, low-volume hospitals had higher short-term mortality than high-volume hospitals. These results from a nationwide database imply that acute SAH should be treated by a skilled neurosurgeon with adequate facilities in a high-volume hospital.
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Lee et al. (2021) conducted a cohort in Subarachnoid hemorrhage (n=625). High-volume hospital admission vs. Low-volume hospital admission was evaluated on 5-year mortality (p=0.004). Admission to high-volume hospitals for subarachnoid hemorrhage treated with clipping or coiling was associated with significantly lower 5-year mortality compared to low-volume hospitals (20.0% vs. 30.0%).
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