PUBLIC RELEASE DATE:
24-Oct-2014
Contact: Connie Hughes Connie.Hughes@wolterskluwer.com 646-674-6348 Wolters Kluwer Health @WKHealth
October 24, 2014 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 outcomesincluding the percentage of patients sent directly home from the hospital and the percentage able to walk independently at dischargewere 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.
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For brain hemorrhage, risk of death is lower at high-volume hospitals