Impact of hospital case-volume on subarachnoid hemorrhage outcomes: a nationwide analysis adjusting for hemorrhage severity
Abstract Objective There have been suggestions that patients with subarachnoid hemorrhage (SAH) have a better outcome when treated in high volume centers. Much of the published literature on the subject is limited by an inability to control for severity of SAH. Methods A nationwide retrospective coh...
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| Veröffentlicht in: | Journal of critical care 2017-02, Vol.37, p.240-243 |
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| creator | Rush, Barret, MD Romano, Kali, MD Ashkanani, Mohammad, MD McDermid, Robert, MD Celi, Leo Anthony, MD, MPH, MS |
| description | Abstract Objective There have been suggestions that patients with subarachnoid hemorrhage (SAH) have a better outcome when treated in high volume centers. Much of the published literature on the subject is limited by an inability to control for severity of SAH. Methods A nationwide retrospective cohort analysis utilizing the Nationwide Inpatient Sample. The Nationwide Inpatient Sample Subarachnoid Severity Scale was employed to adjust for severity of SAH in multivariate logistic regression modelling. Results The records of 47,911,414 hospital admissions from the 2006-2011 NIS samples were examined. There were 11,607 patients who met inclusion criteria for the study. Of these, 7,787 (67.0%) were treated at a high volume center, compared to 3820 (32.9%) treated at a low volume center. Patients treated at high-volume centers compared to low-volume centers were more likely to receive endovascular aneurysm control (58.5% vs 51.2%, p=0.04), be transferred from another hospital (35.4% vs 19.7%, p |
| doi_str_mv | 10.1016/j.jcrc.2016.09.009 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5679218</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0883944116305135</els_id><sourcerecordid>1852657320</sourcerecordid><originalsourceid>FETCH-LOGICAL-c538t-8b9c01b6039c98cdb764c038e70d9fa85dd2abc841c003133bec5647af0fb66d3</originalsourceid><addsrcrecordid>eNp9kk9v1DAQxSMEokvhC3BAlrhwyWLHa8dGqBKq-FOpEgfgbDnjya5DYi92smjFlyfRllJ64OSR5veePPOmKJ4zumaUydfduoME62qu11SvKdUPihUToi6VZOJhsaJK8VJvNuyseJJzRymrORePi7OqlpJXWq6KX1fD3sJIYkt2Me_9aHsCNmN5iP00IImB5KmxycIuRO_IDoeY0s5u59Y0QhwwvyGWBDv6GH56h8QG2x-zz8S6bsqjD1vSxnRXmPGAyY_Hp8Wj1vYZn92858W3D--_Xn4qrz9_vLp8d12C4GosVaOBskZSrkErcE0tN0C5wpo63VolnKtsA2rDgFLOOG8QhNzUtqVtI6Xj58XFyXc_NQM6wDAm25t98oNNRxOtN_92gt-ZbTwYIWtdMTUbvLoxSPHHhHk0g8-AfW8DxikbpkQlRc0rOqMv76FdnNK8khOlFWVKz1R1oiDFnBO2t59h1CzZms4s2ZolW0O1mbOdRS_ujnEr-RPmDLw9ATgv8-AxmQweA6DzCWE0Lvr_-1_ck0Pvgwfbf8cj5r9zmFwZar4s17UcF5OcCsYF_w2sf84J</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1852980189</pqid></control><display><type>article</type><title>Impact of hospital case-volume on subarachnoid hemorrhage outcomes: a nationwide analysis adjusting for hemorrhage severity</title><source>MEDLINE</source><source>Access via ScienceDirect (Elsevier)</source><source>ProQuest Central UK/Ireland</source><creator>Rush, Barret, MD ; Romano, Kali, MD ; Ashkanani, Mohammad, MD ; McDermid, Robert, MD ; Celi, Leo Anthony, MD, MPH, MS</creator><creatorcontrib>Rush, Barret, MD ; Romano, Kali, MD ; Ashkanani, Mohammad, MD ; McDermid, Robert, MD ; Celi, Leo Anthony, MD, MPH, MS</creatorcontrib><description>Abstract Objective There have been suggestions that patients with subarachnoid hemorrhage (SAH) have a better outcome when treated in high volume centers. Much of the published literature on the subject is limited by an inability to control for severity of SAH. Methods A nationwide retrospective cohort analysis utilizing the Nationwide Inpatient Sample. The Nationwide Inpatient Sample Subarachnoid Severity Scale was employed to adjust for severity of SAH in multivariate logistic regression modelling. Results The records of 47,911,414 hospital admissions from the 2006-2011 NIS samples were examined. There were 11,607 patients who met inclusion criteria for the study. Of these, 7,787 (67.0%) were treated at a high volume center, compared to 3820 (32.9%) treated at a low volume center. Patients treated at high-volume centers compared to low-volume centers were more likely to receive endovascular aneurysm control (58.5% vs 51.2%, p=0.04), be transferred from another hospital (35.4% vs 19.7%, p<0.01), treated in a teaching facility (97.3% vs 72.9%, p<0.01), and have a longer length of stay (14.9 days IQR 10.3-21.7 vs 13.9 days IQR 8.9-20.1, p<0.01). After adjustment for all baseline covariates, including severity of SAH, treatment in a high-volume center was associated with an odds ratio (OR) for death of 0.82 (95% CI 0.72-0.95, p<0.01) and a higher odds of a good functional outcome (OR 1.16 95% CI 1.04-1.28, p<0.01). Conclusion After adjustment for severity of SAH, treatment in a high-volume center was associated with a lower risk of in-hospital mortality and a higher odds of a good functional outcome.</description><identifier>ISSN: 0883-9441</identifier><identifier>EISSN: 1557-8615</identifier><identifier>DOI: 10.1016/j.jcrc.2016.09.009</identifier><identifier>PMID: 27663296</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Age ; Aged ; Aneurysms ; Case volume ; Comorbidity ; Critical Care ; Databases, Factual ; Endovascular Procedures ; Female ; Health Facility Size ; Hemorrhage ; Hospital Mortality ; Hospitalization ; Hospitals, High-Volume - statistics & numerical data ; Hospitals, Low-Volume - statistics & numerical data ; Hospitals, Rural ; Hospitals, Teaching - statistics & numerical data ; Hospitals, Urban ; Humans ; Length of Stay ; Logistic Models ; Logistics ; Male ; Middle Aged ; Mortality ; Multivariate Analysis ; Odds Ratio ; Outcomes ; Patient Transfer - statistics & numerical data ; Patients ; Retrospective Studies ; Severity of Illness Index ; Studies ; Subarachnoid hemorrhage ; Subarachnoid Hemorrhage - mortality ; Subarachnoid Hemorrhage - therapy ; United States ; Variables</subject><ispartof>Journal of critical care, 2017-02, Vol.37, p.240-243</ispartof><rights>2016 Elsevier Inc.</rights><rights>Copyright © 2016 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Feb 01, 2017</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c538t-8b9c01b6039c98cdb764c038e70d9fa85dd2abc841c003133bec5647af0fb66d3</citedby><cites>FETCH-LOGICAL-c538t-8b9c01b6039c98cdb764c038e70d9fa85dd2abc841c003133bec5647af0fb66d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1852980189?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>230,315,782,786,887,3554,27933,27934,46004,64394,64396,64398,72478</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27663296$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rush, Barret, MD</creatorcontrib><creatorcontrib>Romano, Kali, MD</creatorcontrib><creatorcontrib>Ashkanani, Mohammad, MD</creatorcontrib><creatorcontrib>McDermid, Robert, MD</creatorcontrib><creatorcontrib>Celi, Leo Anthony, MD, MPH, MS</creatorcontrib><title>Impact of hospital case-volume on subarachnoid hemorrhage outcomes: a nationwide analysis adjusting for hemorrhage severity</title><title>Journal of critical care</title><addtitle>J Crit Care</addtitle><description>Abstract Objective There have been suggestions that patients with subarachnoid hemorrhage (SAH) have a better outcome when treated in high volume centers. Much of the published literature on the subject is limited by an inability to control for severity of SAH. Methods A nationwide retrospective cohort analysis utilizing the Nationwide Inpatient Sample. The Nationwide Inpatient Sample Subarachnoid Severity Scale was employed to adjust for severity of SAH in multivariate logistic regression modelling. Results The records of 47,911,414 hospital admissions from the 2006-2011 NIS samples were examined. There were 11,607 patients who met inclusion criteria for the study. Of these, 7,787 (67.0%) were treated at a high volume center, compared to 3820 (32.9%) treated at a low volume center. Patients treated at high-volume centers compared to low-volume centers were more likely to receive endovascular aneurysm control (58.5% vs 51.2%, p=0.04), be transferred from another hospital (35.4% vs 19.7%, p<0.01), treated in a teaching facility (97.3% vs 72.9%, p<0.01), and have a longer length of stay (14.9 days IQR 10.3-21.7 vs 13.9 days IQR 8.9-20.1, p<0.01). After adjustment for all baseline covariates, including severity of SAH, treatment in a high-volume center was associated with an odds ratio (OR) for death of 0.82 (95% CI 0.72-0.95, p<0.01) and a higher odds of a good functional outcome (OR 1.16 95% CI 1.04-1.28, p<0.01). Conclusion After adjustment for severity of SAH, treatment in a high-volume center was associated with a lower risk of in-hospital mortality and a higher odds of a good functional outcome.</description><subject>Adult</subject><subject>Age</subject><subject>Aged</subject><subject>Aneurysms</subject><subject>Case volume</subject><subject>Comorbidity</subject><subject>Critical Care</subject><subject>Databases, Factual</subject><subject>Endovascular Procedures</subject><subject>Female</subject><subject>Health Facility Size</subject><subject>Hemorrhage</subject><subject>Hospital Mortality</subject><subject>Hospitalization</subject><subject>Hospitals, High-Volume - statistics & numerical data</subject><subject>Hospitals, Low-Volume - statistics & numerical data</subject><subject>Hospitals, Rural</subject><subject>Hospitals, Teaching - statistics & numerical data</subject><subject>Hospitals, Urban</subject><subject>Humans</subject><subject>Length of Stay</subject><subject>Logistic Models</subject><subject>Logistics</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Multivariate Analysis</subject><subject>Odds Ratio</subject><subject>Outcomes</subject><subject>Patient Transfer - statistics & numerical data</subject><subject>Patients</subject><subject>Retrospective Studies</subject><subject>Severity of Illness Index</subject><subject>Studies</subject><subject>Subarachnoid hemorrhage</subject><subject>Subarachnoid Hemorrhage - mortality</subject><subject>Subarachnoid Hemorrhage - therapy</subject><subject>United States</subject><subject>Variables</subject><issn>0883-9441</issn><issn>1557-8615</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kk9v1DAQxSMEokvhC3BAlrhwyWLHa8dGqBKq-FOpEgfgbDnjya5DYi92smjFlyfRllJ64OSR5veePPOmKJ4zumaUydfduoME62qu11SvKdUPihUToi6VZOJhsaJK8VJvNuyseJJzRymrORePi7OqlpJXWq6KX1fD3sJIYkt2Me_9aHsCNmN5iP00IImB5KmxycIuRO_IDoeY0s5u59Y0QhwwvyGWBDv6GH56h8QG2x-zz8S6bsqjD1vSxnRXmPGAyY_Hp8Wj1vYZn92858W3D--_Xn4qrz9_vLp8d12C4GosVaOBskZSrkErcE0tN0C5wpo63VolnKtsA2rDgFLOOG8QhNzUtqVtI6Xj58XFyXc_NQM6wDAm25t98oNNRxOtN_92gt-ZbTwYIWtdMTUbvLoxSPHHhHk0g8-AfW8DxikbpkQlRc0rOqMv76FdnNK8khOlFWVKz1R1oiDFnBO2t59h1CzZms4s2ZolW0O1mbOdRS_ujnEr-RPmDLw9ATgv8-AxmQweA6DzCWE0Lvr_-1_ck0Pvgwfbf8cj5r9zmFwZar4s17UcF5OcCsYF_w2sf84J</recordid><startdate>20170201</startdate><enddate>20170201</enddate><creator>Rush, Barret, MD</creator><creator>Romano, Kali, MD</creator><creator>Ashkanani, Mohammad, MD</creator><creator>McDermid, Robert, MD</creator><creator>Celi, Leo Anthony, MD, MPH, MS</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K6X</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20170201</creationdate><title>Impact of hospital case-volume on subarachnoid hemorrhage outcomes: a nationwide analysis adjusting for hemorrhage severity</title><author>Rush, Barret, MD ; Romano, Kali, MD ; Ashkanani, Mohammad, MD ; McDermid, Robert, MD ; Celi, Leo Anthony, MD, MPH, MS</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c538t-8b9c01b6039c98cdb764c038e70d9fa85dd2abc841c003133bec5647af0fb66d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Age</topic><topic>Aged</topic><topic>Aneurysms</topic><topic>Case volume</topic><topic>Comorbidity</topic><topic>Critical Care</topic><topic>Databases, Factual</topic><topic>Endovascular Procedures</topic><topic>Female</topic><topic>Health Facility Size</topic><topic>Hemorrhage</topic><topic>Hospital Mortality</topic><topic>Hospitalization</topic><topic>Hospitals, High-Volume - statistics & numerical data</topic><topic>Hospitals, Low-Volume - statistics & numerical data</topic><topic>Hospitals, Rural</topic><topic>Hospitals, Teaching - statistics & numerical data</topic><topic>Hospitals, Urban</topic><topic>Humans</topic><topic>Length of Stay</topic><topic>Logistic Models</topic><topic>Logistics</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Multivariate Analysis</topic><topic>Odds Ratio</topic><topic>Outcomes</topic><topic>Patient Transfer - statistics & numerical data</topic><topic>Patients</topic><topic>Retrospective Studies</topic><topic>Severity of Illness Index</topic><topic>Studies</topic><topic>Subarachnoid hemorrhage</topic><topic>Subarachnoid Hemorrhage - mortality</topic><topic>Subarachnoid Hemorrhage - therapy</topic><topic>United States</topic><topic>Variables</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rush, Barret, MD</creatorcontrib><creatorcontrib>Romano, Kali, MD</creatorcontrib><creatorcontrib>Ashkanani, Mohammad, MD</creatorcontrib><creatorcontrib>McDermid, Robert, MD</creatorcontrib><creatorcontrib>Celi, Leo Anthony, MD, MPH, MS</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>British Nursing Index</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of critical care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rush, Barret, MD</au><au>Romano, Kali, MD</au><au>Ashkanani, Mohammad, MD</au><au>McDermid, Robert, MD</au><au>Celi, Leo Anthony, MD, MPH, MS</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of hospital case-volume on subarachnoid hemorrhage outcomes: a nationwide analysis adjusting for hemorrhage severity</atitle><jtitle>Journal of critical care</jtitle><addtitle>J Crit Care</addtitle><date>2017-02-01</date><risdate>2017</risdate><volume>37</volume><spage>240</spage><epage>243</epage><pages>240-243</pages><issn>0883-9441</issn><eissn>1557-8615</eissn><abstract>Abstract Objective There have been suggestions that patients with subarachnoid hemorrhage (SAH) have a better outcome when treated in high volume centers. Much of the published literature on the subject is limited by an inability to control for severity of SAH. Methods A nationwide retrospective cohort analysis utilizing the Nationwide Inpatient Sample. The Nationwide Inpatient Sample Subarachnoid Severity Scale was employed to adjust for severity of SAH in multivariate logistic regression modelling. Results The records of 47,911,414 hospital admissions from the 2006-2011 NIS samples were examined. There were 11,607 patients who met inclusion criteria for the study. Of these, 7,787 (67.0%) were treated at a high volume center, compared to 3820 (32.9%) treated at a low volume center. Patients treated at high-volume centers compared to low-volume centers were more likely to receive endovascular aneurysm control (58.5% vs 51.2%, p=0.04), be transferred from another hospital (35.4% vs 19.7%, p<0.01), treated in a teaching facility (97.3% vs 72.9%, p<0.01), and have a longer length of stay (14.9 days IQR 10.3-21.7 vs 13.9 days IQR 8.9-20.1, p<0.01). After adjustment for all baseline covariates, including severity of SAH, treatment in a high-volume center was associated with an odds ratio (OR) for death of 0.82 (95% CI 0.72-0.95, p<0.01) and a higher odds of a good functional outcome (OR 1.16 95% CI 1.04-1.28, p<0.01). Conclusion After adjustment for severity of SAH, treatment in a high-volume center was associated with a lower risk of in-hospital mortality and a higher odds of a good functional outcome.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27663296</pmid><doi>10.1016/j.jcrc.2016.09.009</doi><tpages>4</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of critical care, 2017-02, Vol.37, p.240-243 |
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| subjects | Adult Age Aged Aneurysms Case volume Comorbidity Critical Care Databases, Factual Endovascular Procedures Female Health Facility Size Hemorrhage Hospital Mortality Hospitalization Hospitals, High-Volume - statistics & numerical data Hospitals, Low-Volume - statistics & numerical data Hospitals, Rural Hospitals, Teaching - statistics & numerical data Hospitals, Urban Humans Length of Stay Logistic Models Logistics Male Middle Aged Mortality Multivariate Analysis Odds Ratio Outcomes Patient Transfer - statistics & numerical data Patients Retrospective Studies Severity of Illness Index Studies Subarachnoid hemorrhage Subarachnoid Hemorrhage - mortality Subarachnoid Hemorrhage - therapy United States Variables |
| title | Impact of hospital case-volume on subarachnoid hemorrhage outcomes: a nationwide analysis adjusting for hemorrhage severity |
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