Lower mortality at hospitals with more experience treating subarachnoid hemorrhage, reports neurosurgery
For patients with a severe type of stroke called subarachnoid hemorrhage (SAH), treatment at a hospital that treats a high volume of SAH cases is associated with a lower risk of death, reports a study in the November issue of Neurosurgery, official journal of the Congress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.
After adjustment for other factors, the mortality rate after SAH is about one-fifth lower at high-volume hospitals, according to the report by Dr. Shyam Prabhakaran of Northwestern University, Chicago and colleagues. They write, "Our data suggest that experienced centers may provide more optimized care for SAH patients."
Hospital Volume Linked to SAH Mortality
Using data from a nationwide quality improvement program (the Get With the Guidelines-Stroke registry), the researchers identified nearly 32,000 patients with SAH treated at 685 US hospitals between 2003 and 2012. Subarachnoid hemorrhage is a type of stroke in which there is bleeding into the brain, most commonly caused by a ruptured aneurysm.
The study compared mortality rates and other outcomes for patients treated at hospitals with different volumes of SAH patients. The number of SAH cases treated per year ranged from as low as four at the lowest-volume hospitals to 13 or more at the highest-volume hospitals.
The risk of in-hospital death decreased as hospital volume of SAH cases increased: from 29.5 percent at the lowest-volume hospitals to 22.1 percent at the highest-volume hospitals. The difference remained significant after adjustment for differences in patient and hospital characteristics. In that analysis, mortality risk was about one-fifth lower at hospitals with the highest volume of SAH patients, compared to the lowest volume.
Other important SAH outcomes—including the percentage of patients sent directly home from the hospital and the percentage able to walk independently at discharge—were similar between high- and low-volume hospitals. In further analyses, an upper limit of hospital case volume was not identified above which the mortality benefit was not seen; instead, for every 5 cases, there was a 3% relative reduction in mortality.
Findings Add Support for Centralized Stroke Care
Patients treated at high-volume hospitals spent more time in the hospital: median 12 days, compared to five days at low-volume hospitals. This might be an indicator of "more aggressive care including monitoring for complications," Dr. Prabhakaran and coauthors write. However, they note their database did not include information on the specific services and treatments provided.
The results add to previous studies suggesting that hospitals treating a higher volume of patients with SAH may achieve better outcomes. The Get With the Guidelines-Stroke registry provides the opportunity to assess the effects of hospital volume in a large contemporary sample of patients, treated since the introduction of more recent advances in SAH care.
The results show a lower risk of death for SAH patients treated at higher-volume hospitals, independent of patient and other hospital characteristics. Within the limitations of the data, the study adds support to the concept of treating stroke at Comprehensive Stroke Centers—which combine key resources and expertise needed to improve care for complex stroke conditions such as SAH. Dr. Prabhakaran and colleagues conclude, "Our results may have significant implications for regional stroke policies and procedures and affirm the recent recommendations that patients with SAH be treated at high-volume centers."
Neurosurgery, the Official Journal of the Congress of Neurological Surgeons, is your most complete window to the contemporary field of neurosurgery. Members of the Congress and non-member subscribers receive 3,000 pages per year packed with the very latest science, technology, and medicine, not to mention full-text online access to the world's most complete, up-to-the-minute neurosurgery resource. For professionals aware of the rapid pace of developments in the field, Neurosurgery is nothing short of indispensable.
About Wolters Kluwer Health
Wolters Kluwer Health is a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Serving more than 150 countries worldwide, clinicians rely on Wolters Kluwer Health's market leading information-enabled tools and software solutions throughout their professional careers from training to research to practice. Major brands include Health Language®, Lexicomp®, Lippincott Williams & Wilkins, Medicom®, Medknow, Ovid®, Pharmacy OneSource®, ProVation® Medical and UpToDate®.
Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company. Wolters Kluwer had 2013 annual revenues of €3.6 billion ($4.7 billion), employs approximately 19,000 people worldwide, and maintains operations in over 40 countries across Europe, North America, Asia Pacific, and Latin America.maintains operations in over 40 countries across Europe, North America, Asia Pacific, and Latin America. Wolters Kluwer is headquartered in Alphen aan den Rijn, the Netherlands. Its shares are quoted on Euronext Amsterdam (WKL) and are included in the AEX and Euronext 100 indices. Wolters Kluwer has a sponsored Level 1 American Depositary Receipt program. The ADRs are traded on the over-the-counter market in the U.S. (WTKWY).
Follow our official Twitter handle: @WKHealth.
Connie Hughes | Eurek Alert!
Researchers simplify tiny structures' construction drip by drip
12.11.2018 | Princeton University, Engineering School
Mandibular movement monitoring may help improve oral sleep apnea devices
06.11.2018 | Elsevier
Faster and secure data communication: This is the goal of a new joint project involving physicists from the University of Würzburg. The German Federal Ministry of Education and Research funds the project with 14.8 million euro.
In our digital world data security and secure communication are becoming more and more important. Quantum communication is a promising approach to achieve...
On Saturday, 10 November 2018, the research icebreaker Polarstern will leave its homeport of Bremerhaven, bound for Cape Town, South Africa.
When choosing materials to make something, trade-offs need to be made between a host of properties, such as thickness, stiffness and weight. Depending on the application in question, finding just the right balance is the difference between success and failure
Now, a team of Penn Engineers has demonstrated a new material they call "nanocardboard," an ultrathin equivalent of corrugated paper cardboard. A square...
Physicists at ETH Zurich demonstrate how errors that occur during the manipulation of quantum system can be monitored and corrected on the fly
The field of quantum computation has seen tremendous progress in recent years. Bit by bit, quantum devices start to challenge conventional computers, at least...
Scientists developed specially coated nanometer-sized vehicles that can be actively moved through dense tissue like the vitreous of the eye. So far, the transport of nano-vehicles has only been demonstrated in model systems or biological fluids, but not in real tissue. The work was published in the journal Science Advances and constitutes one step further towards nanorobots becoming minimally-invasive tools for precisely delivering medicine to where it is needed.
Researchers of the “Micro, Nano and Molecular Systems” Lab at the Max Planck Institute for Intelligent Systems in Stuttgart, together with an international...
09.11.2018 | Event News
06.11.2018 | Event News
23.10.2018 | Event News
12.11.2018 | Life Sciences
12.11.2018 | Materials Sciences
12.11.2018 | Physics and Astronomy