Impact of hospital case-volume on subarachnoid hemorrhage outcomes: A nationwide analysis adjusting for hemorrhage severity

Object. The goal of this study was to determine whether a hospital's volume of subarachnoid hemorrhage (SAH) cases affects mortality rates in patients with SAH. For certain serious illnesses and surgical procedures, outcome has been associated with hospital case volume. Subarachnoid hemorrhage, usually resulting from a ruptured cerebral aneurysm, yields a high mortality rate. There has been no multistate study of a diverse set of hospitals to determine whether in-hospital mortality rates are influenced by hospital volume of SAH cases. Methods. The authors conducted an analysis of a retrospective, administrative database of 16,399 hospitalizations for SAH (9290 admitted through emergency departments). These hospitalizations were from acute-care hospitals in 18 states representing 58% of the US population. Both univariate and multivariate analyses were used to assess the case volume—mortality rate relationship. The authors used patient age, sex, Medicaid status, hospital region, data source year, hospital case volume quartile, and a comorbidity index in multivariate generalized estimating equations to model the relationship between hospital volume and mortality rates after SAH. Patients with SAH who were treated in hospitals in which low volumes of patients with SAH are admitted through the emergency department had 1.4 times the odds of dying in the hospital (95% confidence interval 1.2–1.6) as patients admitted to high-volume hospitals after controlling for patient age, sex, Medicaid status, hospital region, database year, and comorbid conditions. Conclusions. Patients with a diagnosis of SAH on their discharge records who initially presented through the emergency department of a hospital with a high volume of SAH cases had significantly lower mortality rates. Concentrating care for this disease in high-volume SAH treatment centers may improve overall survival.

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Hospital Case Volume Is Associated With Mortality in Patients Hospitalized With Subarachnoid Hemorrhage

Neurosurgery ◽

10.1227/neu.0000000000000475 ◽

2014 ◽

Vol 75 (5) ◽

pp. 500-508 ◽

Cited By ~ 20

Author(s):

Shyam Prabhakaran ◽

Gregg C. Fonarow ◽

Eric E. Smith ◽

Li Liang ◽

Ying Xian ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Case Volume ◽

Hospital Case

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Hospital case-volume is associated with case-fatality after aneurysmal subarachnoid hemorrhage

International Journal of Stroke ◽

10.1177/1747493018790073 ◽

2018 ◽

Vol 14 (3) ◽

pp. 282-289 ◽

Cited By ~ 2

Author(s):

Antti Lindgren ◽

Sarah Burt ◽

Ellie Bragan Turner ◽

Atte Meretoja ◽

Jin-Moo Lee ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Treatment Modality ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Tertiary Care ◽

Case Fatality ◽

High Volume ◽

Day Case ◽

Case Volume ◽

Hospital Case ◽

Low Volume

Background Inverse association between hospital case-volume and case-fatality has been observed for various nonsurgical interventions and surgical procedures. Aims To study the impact of hospital case-volume on outcome after aneurysmal subarachnoid hemorrhage (aSAH). Methods We included aSAH patients who underwent aneurysm coiling or clipping from tertiary care medical centers across three continents using the Dr Foster Stroke GOAL database 2007–2014. Hospitals were categorized by annual case-volume (low volume: <41/year; intermediate: 41–70/year; high: >70/year). Primary outcome was 14-day in-hospital case-fatality. We calculated proportions, and used multiple logistic regression to adjust for age, sex, differences in comorbidity or disease severity, aneurysm treatment modality, and hospital. Results We included 8525 patients (2363 treated in low volume hospitals, 3563 treated in intermediate volume hospitals, and 2599 in high-volume hospitals). Crude 14-day case-fatality for hospitals with low case-volume was 10.4% (95% confidence interval (CI) 9.2–11.7%), for intermediate volume 7.0% (95% CI 6.2–7.9%; adjusted odds ratio (OR) 0.63 (95%CI 0.47–0.85)) and for high volume 5.4% (95% CI 4.6–6.3%; adjusted OR 0.50 (95% CI 0.33–0.74)). In patients with clipped aneurysms, adjusted OR for 14-day case-fatality was 0.46 (95% CI 0.30–0.71) for hospitals with intermediate case-volume and 0.42 (95% CI 0.25–0.72) with high case-volume. In patients with coiled aneurysms, adjusted OR was 0.77 (95% CI 0.55–1.07) for hospitals with intermediate case-volume and 0.56 (95% CI 0.36–0.87) with high case-volume. Conclusions Even within a subset of large, tertiary care centers, intermediate and high hospital case-volume is associated with lower case-fatality after aSAH regardless of treatment modality, supporting centralization to higher volume centers.

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The association between hospital case‐volume and postoperative outcomes after esophageal cancer surgery: A population‐based retrospective cohort study

Thoracic Cancer ◽

10.1111/1759-7714.14096 ◽

2021 ◽

Author(s):

Bo Rim Kim ◽

Eun Jin Jang ◽

Junwoo Jo ◽

Hannah Lee ◽

Dong Yeon Jang ◽

...

Keyword(s):

Esophageal Cancer ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Population Based ◽

Cancer Surgery ◽

Postoperative Outcomes ◽

Case Volume ◽

Hospital Case ◽

Esophageal Cancer Surgery

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Is Risk of Secondary Surgery for Oronasal Fistula Following Primary Cleft Palate Repair Associated With Hospital Case Volume and Cost-to-Charge Ratio?

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665620959528 ◽

2021 ◽

Vol 58 (5) ◽

pp. 603-611

Author(s):

Giap H. Vu ◽

Christopher L. Kalmar ◽

Carrie E. Zimmerman ◽

Laura S. Humphries ◽

Jordan W. Swanson ◽

...

Keyword(s):

Cleft Palate ◽

Outcome Measure ◽

Charge Ratio ◽

Fistula Repair ◽

Case Volume ◽

Secondary Surgery ◽

Hospital Case ◽

Oronasal Fistula ◽

Cleft Palate Repair ◽

Palate Repair

Objective: This study assesses the association between risk of secondary surgery for oronasal fistula following primary cleft palate repair and 2 hospital characteristics—cost-to-charge ratio (RCC) and case volume of cleft palate repair. Design: Retrospective cohort study. Setting: This study utilized the Pediatric Health Information System (PHIS) database, which consists of clinical and resource-utilization data from >49 hospitals in the United States. Patients and Participants: Patients undergoing primary cleft palate repair from 2004 to 2009 were abstracted from the PHIS database and followed up for oronasal fistula repair between 2004 and 2015. Main Outcome Measure(s): The primary outcome measure was whether patients underwent oronasal fistula repair after primary cleft palate repair. Results: Among 5745 patients from 45 institutions whom met inclusion criteria, 166 (3%) underwent oronasal fistula repair within 6 to 11 years of primary cleft palate repair. Primary palatoplasty at high-RCC facilities was associated with a higher rate of subsequent oronasal fistula repair (odds ratio [OR] = 1.84 [1.32-2.56], adjusted odds ratio [AOR] = 1.81 [1.28-2.59]; P ≤ .001). Likelihood of surgery for oronasal fistula was independent of hospital case volume (OR = 0.83 [0.61-1.13], P = .233; AOR = 0.86 [0.62-1.20], P = .386). Patients with complete unilateral or bilateral cleft palate were more likely to receive oronasal fistula closure compared to those with unilateral-incomplete cleft palate (AOR = 2.09 [1.27-3.56], P = .005; AOR = 3.14 [1.80-5.58], P < .001). Conclusions: Subsequent need for oronasal fistula repair, while independent of hospital case volume for cleft palate repair, increased with increasing hospital RCC. Our study also corroborates complete cleft palate and cleft lip as risk factors for oronasal fistula.

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