Impact of case volume on aneurysmal subarachnoid hemorrhage outcomes

被引:24
作者
Chang, Tiffany R. [1 ,2 ]
Kowalski, Robert G. [3 ]
Carhuapoma, J. Ricardo [3 ,4 ,5 ]
Tamargo, Rafael J. [3 ,5 ]
Naval, Neeraj S. [3 ,4 ,5 ]
机构
[1] Univ Texas Houston, Sch Med, Dept Neurosurg, Houston, TX 77030 USA
[2] Univ Texas Houston, Sch Med, Dept Neurol, Houston, TX 77030 USA
[3] Johns Hopkins Univ, Sch Med, Anesthesia Crit Care Med, Baltimore, MD USA
[4] Johns Hopkins Univ, Sch Med, Dept Neurol, Baltimore, MD 21205 USA
[5] Johns Hopkins Univ, Sch Med, Dept Neurosurg, Baltimore, MD 21205 USA
关键词
Subarachnoid hemorrhage; Aneurysm; Neurocritical care unit; Case volume; Caseload; Outcome; SPECIALIZED NEUROCRITICAL CARE; HOSPITAL VOLUME; MORTALITY; STROKE; NEUROINTENSIVIST; ASSOCIATION; MANAGEMENT;
D O I
10.1016/j.jcrc.2015.01.007
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Purpose: To compare aneurysmal subarachnoid hemorrhage (aSAH) outcomes between high- and low-volume referral centers with dedicated neurosciences critical care units (NCCUs) and shared neurosurgical, endovascular, and neurocritical care practitioners. Materials and Methods: Prospectively collected data of aSAH patients admitted to 2 institutional NCCUs were reviewed. NCCU A is a 22-bed unit staffed 24/7 with overnight in-house NCCU fellow and resident coverage. NCCU B is a 14-bed unit with home call by NCCU attending/fellow and in-house residents. Results: A total of 161 aSAH patients (27%) were admitted to NCCU B compared with 447 at NCCU A (73%). Among factors that independently impacted hospital mortality, there were no differences in baseline characteristics: mean age (A: 53.5 +/- 14.1 years, B: 53.1 +/- 13.6 years), poor grade Hunt and Hess (A: 28.2%, B: 26.7%), presence of multiple medical comorbidities (A: 28%, B: 31.1%), and associated cocaine use (A: 11.6%, B: 14.3%). There was no significant difference in hospital mortality (A: 17.9%, B: 18%), poor functional outcome (A: 30%, B: 25.4%), aneurysm rerupture (A: 2.8%, B: 2.4%), or delayed cerebral ischemia (A: 14.1%, B: 16.1%). Conclusions: The noninferior outcomes at the lower SAH volume center suggests that provider expertise, not patient volume, is critical to providing high-quality specialized care. (C) 2015 Elsevier Inc. All rights reserved.
引用
收藏
页码:469 / 472
页数:4
相关论文
共 25 条
[21]   Impact of a Dedicated Neurocritical Care Team in Treating Patients with Aneurysmal Subarachnoid Hemorrhage [J].
Samuels, Owen ;
Webb, Adam ;
Culler, Steve ;
Martin, Kathleen ;
Barrow, Daniel .
NEUROCRITICAL CARE, 2011, 14 (03) :334-340
[22]   Length of stay and mortality in neurocritically ill patients: Impact of a specialized neurocritical care team [J].
Suarez, JI ;
Zaidat, OO ;
Suri, MF ;
Feen, ES ;
Lynch, G ;
Hickman, J ;
Georgiadis, A ;
Selman, WR .
CRITICAL CARE MEDICINE, 2004, 32 (11) :2311-2317
[23]   The Association of Hospital Volume With Mortality and Costs of Care for Stroke in Japan [J].
Tsugawa, Yusuke ;
Kumamaru, Hiraku ;
Yasunaga, Hideo ;
Hashimoto, Hideki ;
Horiguchi, Hiromasa ;
Ayanian, John Z. .
MEDICAL CARE, 2013, 51 (09) :782-788
[24]   The Impact of a Neuro-Intensivist on Patients with Stroke Admitted to a Neurosciences Intensive Care Unit [J].
Varelas, Panayiotis N. ;
Schultz, Lonni ;
Conti, Mary ;
Spanaki, Marianna ;
Genarrelli, Thomas ;
Hacein-Bey, Lotfi .
NEUROCRITICAL CARE, 2008, 9 (03) :293-299
[25]   Impact of a neurointensivist on outcomes in patients with head trauma treated in a neurosciences intensive care unit [J].
Varelas, PN ;
Eastwood, D ;
Yun, HJ ;
Spanaki, MV ;
Bey, LH ;
Kessaris, C ;
Gennarelli, TA .
JOURNAL OF NEUROSURGERY, 2006, 104 (05) :713-719