Short and Long-term Outcomes of Subarachnoid Hemorrhage Treatment according to Hospital Volume in Korea: a Nationwide Multicenter Registry
10.3346/jkms.2021.36.e146
- Author:
Ji Young LEE
1
;
Nam-Hun HEO
;
Man Ryul LEE
;
Jae Min AHN
;
Hyuk-Jin OH
;
Jai Joon SHIM
;
Seok Mann YOON
;
Bo Yeon LEE
;
Ji Hyeonv SHIN
;
Jae Sang OH
Author Information
1. Department of Neurosurgery, College of Medicine, Soonchunhyang University, Cheonan Hospital, Cheonan, Korea
- Publication Type:Original Article
- From:Journal of Korean Medical Science
2021;36(22):e146-
- CountryRepublic of Korea
- Language:English
-
Abstract:
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 shortand 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, lowvolume hospitals had significantly higher mortality than high-volume hospitals during shortterm 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, lowvolume 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.
