Variability in Outcome After Elective Cerebral Aneurysm Repair in High-Volume Academic Medical Centers

被引:27
作者
Zacharia, Brad E. [1 ]
Bruce, Samuel S. [1 ]
Carpenter, Amanda M. [1 ]
Hickman, Zachary L. [1 ]
Vaughan, Kerry A. [1 ]
Richards, Catherine [2 ]
Gold, William E. [3 ,4 ]
Lu, June [4 ]
Appelboom, Geoffrey [1 ]
Solomon, Robert A. [1 ]
Connolly, E. Sander [1 ]
机构
[1] Columbia Univ, Dept Neurol Surg, Coll Phys & Surg, New York, NY 10032 USA
[2] Columbia Univ, Dept Epidemiol, Coll Phys & Surg, New York, NY 10032 USA
[3] Columbia Univ, Dept Hlth Policy & Management, Mailman Sch Publ Hlth, New York, NY 10032 USA
[4] Gold Hlth Strategies Inc, New York, NY USA
关键词
intracranial aneurysm; neurosurgery; UNRUPTURED INTRACRANIAL ANEURYSMS; SURGICAL-TREATMENT; UNITED-STATES; SURGERY; PREVALENCE; MORTALITY; STROKE; TRENDS;
D O I
10.1161/STROKEAHA.113.004412
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background and Purpose Unruptured intracranial aneurysm repair is the most commonly performed procedure for the prevention of hemorrhagic stroke. Despite efforts to regionalize care in high-volume centers, overall results have improved little. This study aims to determine the effectiveness in improving outcomes of previous efforts to regionalize unruptured intracranial aneurysm repair to high-volume centers and to recommend future steps toward that goal. Methods Using data obtained via the New York Statewide Planning and Research Cooperative System, this study included all patients admitted to any of the 10 highest volume centers in New York state between 2005 and 2010 with a principal diagnosis of unruptured intracranial aneurysm who were treated either by microsurgical or endovascular repair. Mixed-effects logistic regression was used to determine the degree to which hospital-level and patient-level variables contributed to observed variation in good outcome, defined as discharge to home, between hospitals. Results Of 3499 patients treated during the study period, 2692 (76.9%) were treated at the 10 highest volume centers, with 2198 (81.6%) experiencing a good outcome. Good outcomes varied widely between centers, with 44.6% to 91.1% of clipped patients and 75.4% to 92.1% of coiled patients discharged home. Mixed-effects logistic regression revealed that procedural volume accounts for 85.8% of the between-hospital variation in outcome. Conclusions There is notable interhospital heterogeneity in outcomes among even the largest volume unruptured intracranial aneurysm referral centers. Although further regionalization may be needed, mandatory participation in prospective, adjudicated registries will be necessary to reliably identify factors associated with superior outcomes.
引用
收藏
页码:1447 / 1452
页数:6
相关论文
共 37 条
  • [21] Regional Differences in Case Mix and Peri-operative Outcome After Elective Abdominal Aortic Aneurysm Repair in the Vascunet Database
    Mani, K.
    Venermo, M.
    Beiles, B.
    Menyhei, G.
    Altreuther, M.
    Loftus, I.
    Bjorck, M.
    [J]. EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, 2015, 49 (06) : 646 - 652
  • [22] Identifying Women at High Risk of 90 Day Death after Elective Open Abdominal Aortic Aneurysm Repair: A Multicentre Case Control Study
    Tedjawirja, Victoria N.
    Bulder, Ruth M. A.
    Lindeman, Jan H. N.
    Hamming, Jaap F.
    van Dieren, Susan
    Balm, Ron
    Koelemay, Mark J. W.
    [J]. EJVES VASCULAR FORUM, 2022, 57 : 17 - 27
  • [23] Predictors of 30-Day Postoperative Outcome after Elective Endovascular Abdominal Aortic Aneurysm Repair: A Tertiary Referral Center Experience
    Ntalouka, Maria P.
    Nana, Petroula
    Brotis, Alexandros
    Chatzis, Athanasios
    Mermiri, Maria
    Stamoulis, Konstantinos
    Bareka, Metaxia
    Giannoukas, Athanasios
    Matsagkas, Miltiadis
    Arnaoutoglou, Eleni
    [J]. JOURNAL OF CLINICAL MEDICINE, 2023, 12 (18)
  • [24] The Use of Critical Care Services After Orthopedic Surgery at a High-Volume Orthopedic Medical Center: A Retrospective Study
    Zhong, Haoyan
    Garvin, Sean
    Poeran, Jashvant
    Liu, Jiabin
    Kirksey, Meghan
    Wilson, Lauren A.
    DeMeo, Danya
    Yang, Elaine
    Hong, Genewoo
    Jules-Elysee, Kethy M.
    Nejim, Jemiel
    Memtsoudis, Stavros G.
    [J]. HSS JOURNAL, 2022, 18 (03) : 344 - 350
  • [25] Postoperative Outcomes After Laparoscopic Liver Resections in Low and High-Volume Centers: A Multicentric Case-Matched Comparative Study
    Bouras, Ahmed Fouad
    Decanter, Gauthier
    Marin, Helene
    Bouzid, Chafik
    Gayet, Brice
    Liddo, Guido
    Fuks, David
    [J]. WORLD JOURNAL OF SURGERY, 2022, 46 (02) : 362 - 369
  • [26] The impact of July hospital admission on outcome after surgery for spinal metastases at academic medical centers in the United States, 2005 to 2008
    Dasenbrock, Hormuzdiyar H.
    Clarke, Michelle J.
    Thompson, Richard E.
    Gokaslan, Ziya L.
    Bydon, Ali
    [J]. CANCER, 2012, 118 (05) : 1429 - 1438
  • [27] Physiologic Component of the Estimation of Physiologic Ability and Surgical Stress Scoring System as a Predictor of Immediate Outcome After Elective Open Abdominal Aortic Aneurysm Repair
    Menezes, Fabio Huesemann
    Gomes de Souza, Vinicius Meneguette
    [J]. ANNALS OF VASCULAR SURGERY, 2011, 25 (04) : 485 - 495
  • [28] Analysis of Outcome after using High-risk Criteria Selection to Surgery Versus Endovascular Repair in the Modern Era of Abdominal Aortic Aneurysm Treatment
    Steinmetz, E.
    Abello, N.
    Kretz, B.
    Gauthier, E.
    Bouchot, O.
    Brenot, R.
    [J]. EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, 2010, 39 (04) : 403 - 409
  • [29] Incidence and risk factors for umbilical trocar site hernia after laparoscopic TAPP repair. A single high-volume center experience
    Harriott, Camila Bras
    Dreifuss, Nicolas H.
    Schlottmann, Francisco
    Sadava, Emmanuel E.
    [J]. SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, 2021, 35 (09): : 5167 - 5172
  • [30] Survival Outcome and Prognostic Factors After Pulmonary Metastasectomy in Sarcoma Patients A 18-Year Experience at a Single High-volume Referral Center
    Cariboni, Umberto
    De Sanctis, Rita
    Giaretta, Marta
    Voulaz, Emanuele
    Morenghi, Emanuela
    Colombo, Piergiuseppe
    Novellis, Pierluigi
    Bottoni, Edoardo
    Errico, Valentina
    Crepaldi, Alessandro
    Marrari, Andrea
    Navarria, Pierina
    Ascolese, Anna M.
    Testori, Alberto
    Scorsetti, Marta
    Quagliuolo, Vittorio
    Santoro, Armando
    Alloisio, Marco
    [J]. AMERICAN JOURNAL OF CLINICAL ONCOLOGY-CANCER CLINICAL TRIALS, 2019, 42 (01): : 6 - 11