Short and Long-term Outcomes of Subarachnoid Hemorrhage Treatment according to Hospital Volume in Korea: a Nationwide Multicenter Registry
Autor: | Jae-Min Ahn, Nam Hun Heo, Man Ryul Lee, Seok-Mann Yoon, Bo Yeon Lee, Ji Hyeon Shin, Ji Young Lee, Jai Joon Shim, Hyuk-Jin Oh, Jae-Sang Oh |
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Rok vydání: | 2021 |
Předmět: |
Adult
Male medicine.medical_specialty Subarachnoid hemorrhage Adolescent Databases Factual medicine.medical_treatment Kaplan-Meier Estimate 03 medical and health sciences Postoperative Complications 0302 clinical medicine Hospital volume Republic of Korea medicine Long term outcomes Humans Registries cardiovascular diseases 030212 general & internal medicine Mortality Stroke Aged business.industry Proportional hazards model Neurointensive care General Medicine Clipping (medicine) Subarachnoid Hemorrhage Middle Aged medicine.disease Emergency & Critical Care Medicine nervous system diseases Treatment Outcome Emergency medicine Original Article Female Neurosurgery business |
Zdroj: | Journal of Korean Medical Science |
ISSN: | 1598-6357 1011-8934 |
Popis: | 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. Graphical Abstract |
Databáze: | OpenAIRE |
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