TY - JOUR
T1 - Association between hospital volumes and clinical outcomes for patients with nontraumatic subarachnoid hemorrhage
AU - Leifer, Dana
AU - Fonarow, Gregg C.
AU - Hellkamp, Anne
AU - Baker, David
AU - Hoh, Brian L.
AU - Prabhakaran, Shyam
AU - Schoeberl, Mark
AU - Suter, Robert
AU - Washington, Chad
AU - Williams, Scott
AU - Xian, Ying
AU - Schwamm, Lee H.
N1 - Funding Information:
Dr Leifer has served on the AHA Hospital Accreditation Science Committee (HASC) and is on the New York State Department of Health Stroke Physician Advisory Panel. Dr Fonarow receives research funding from the Patient Centered Outcome Research Institute, serves on the AHA HASC, and is employed by the University of California Regents which have a patent on endovascular devices. Drs Baker and Williams are employed by the JC, Mr Schoeberl by the AHA and Dr Suter formerly by the AHA. Dr Schwamm serves as chair of the AHA HASC and Quality Oversight Committees and as a member of the JC Technical Advisory Panel for CSCs. The remaining authors have no disclosures to report.
Publisher Copyright:
© 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2021/8/3
Y1 - 2021/8/3
N2 - BACKGROUND: Previous studies of patients with nontraumatic subarachnoid hemorrhage (SAH) suggest better outcomes at hospitals with higher case and procedural volumes, but the shape of the volume-outcome curve has not been defined. We sought to establish minimum volume criteria for SAH and aneurysm obliteration procedures that could be used for comprehensive stroke center certification. METHODS AND RESULTS: Data from 8512 discharges in the National Inpatient Sample (NIS) from 2010 to 2011 were analyzed using logistic regression models to evaluate the association between clinical outcomes (in-hospital mortality and the NISSAH Outcome Measure [NIS-SOM]) and measures of hospital annual case volume (nontraumatic SAH discharges, coiling, and clipping procedures). Sensitivity and specificity analyses for the association of desirable outcomes with different volume thresholds were performed. During 8512 SAH hospitalizations, 28.7% of cases underwent clipping and 20.1% underwent coiling with rates of 21.2% for in-hospital mortality and 38.6% for poor outcome on the NIS-SOM. The mean (range) of SAH, coiling, and clipping annual case volumes were 30.9 (1–195), 8.7 (0–94), and 6.1 (0–69), respectively. Logistic regression demonstrated improved outcomes with increasing annual case volumes of SAH discharges and procedures for aneurysm obliteration, with attenuation of the benefit beyond 35 SAH cases/year. Analysis of sensitivity and specificity using different volume thresholds confirmed these results. Analysis of previously proposed volume thresholds, including those utilized as minimum standards for comprehensive stroke center certification, showed that hospitals with more than 35 SAH cases annually had consistently superior outcomes compared with hospitals with fewer cases, although some hospitals below this threshold had similar outcomes. The adjusted odds ratio demonstrating lower risk of poor outcomes with SAH annual case volume ≥35 compared with 20 to 34 was 0.82 for the NIS-SOM (95% CI, 0.71–094; P=0.0054) and 0.80 (95% CI, 0.68–0.93; P=0.0055) for in-hospital mortality. CONCLUSIONS: Outcomes for patients with SAH improve with increasing hospital case volumes and procedure volumes, with consistently better outcomes for hospitals with more than 35 SAH cases per year.
AB - BACKGROUND: Previous studies of patients with nontraumatic subarachnoid hemorrhage (SAH) suggest better outcomes at hospitals with higher case and procedural volumes, but the shape of the volume-outcome curve has not been defined. We sought to establish minimum volume criteria for SAH and aneurysm obliteration procedures that could be used for comprehensive stroke center certification. METHODS AND RESULTS: Data from 8512 discharges in the National Inpatient Sample (NIS) from 2010 to 2011 were analyzed using logistic regression models to evaluate the association between clinical outcomes (in-hospital mortality and the NISSAH Outcome Measure [NIS-SOM]) and measures of hospital annual case volume (nontraumatic SAH discharges, coiling, and clipping procedures). Sensitivity and specificity analyses for the association of desirable outcomes with different volume thresholds were performed. During 8512 SAH hospitalizations, 28.7% of cases underwent clipping and 20.1% underwent coiling with rates of 21.2% for in-hospital mortality and 38.6% for poor outcome on the NIS-SOM. The mean (range) of SAH, coiling, and clipping annual case volumes were 30.9 (1–195), 8.7 (0–94), and 6.1 (0–69), respectively. Logistic regression demonstrated improved outcomes with increasing annual case volumes of SAH discharges and procedures for aneurysm obliteration, with attenuation of the benefit beyond 35 SAH cases/year. Analysis of sensitivity and specificity using different volume thresholds confirmed these results. Analysis of previously proposed volume thresholds, including those utilized as minimum standards for comprehensive stroke center certification, showed that hospitals with more than 35 SAH cases annually had consistently superior outcomes compared with hospitals with fewer cases, although some hospitals below this threshold had similar outcomes. The adjusted odds ratio demonstrating lower risk of poor outcomes with SAH annual case volume ≥35 compared with 20 to 34 was 0.82 for the NIS-SOM (95% CI, 0.71–094; P=0.0054) and 0.80 (95% CI, 0.68–0.93; P=0.0055) for in-hospital mortality. CONCLUSIONS: Outcomes for patients with SAH improve with increasing hospital case volumes and procedure volumes, with consistently better outcomes for hospitals with more than 35 SAH cases per year.
KW - Case volumes
KW - Cerebral aneurysm
KW - Clipping
KW - Coiling
KW - Comprehensive stroke centers
KW - Outcomes
KW - Subarachnoid hemorrhage
UR - http://www.scopus.com/inward/record.url?scp=85112097172&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85112097172&partnerID=8YFLogxK
U2 - 10.1161/JAHA.120.018373
DO - 10.1161/JAHA.120.018373
M3 - Article
C2 - 34325522
AN - SCOPUS:85112097172
SN - 2047-9980
VL - 10
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 15
M1 - e018373
ER -