scholarly journals Caseload as a factor for outcome in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis

2014 ◽  
Vol 120 (3) ◽  
pp. 605-611 ◽  
Author(s):  
Hieronymus D. Boogaarts ◽  
Martinus J. van Amerongen ◽  
Joost de Vries ◽  
Gert P. Westert ◽  
André L. M. Verbeek ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Hospital Mortality ◽  
Random Effects ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Meta Analysis ◽  
Relative Weight ◽  
High Volume ◽  
Cochrane Library ◽  
Endovascular Coiling ◽  
Low Volume

Object Increasing evidence exists that treatment of complex medical conditions in high-volume centers is found to improve outcome. Patients with subarachnoid hemorrhage (SAH), a complex disease, probably also benefit from treatment at a high-volume center. The authors aimed to determine, based on published literature, whether a higher hospital caseload is associated with improved outcomes of patients undergoing treatment after aneurysmal subarachnoid hemorrhage. Methods The authors identified studies from MEDLINE, Embase, and the Cochrane Library up to September 28, 2012, that evaluated outcome in high-volume versus low-volume centers in patients with SAH who were treated by either clipping or endovascular coiling. No language restrictions were set. The compared outcome measure was in-hospital mortality. Mortality in studies was pooled in a random effects meta-analysis. Study quality was reported according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria. Results Four articles were included in this analysis, representing 36,600 patients. The quality of studies was graded low in 3 and very low in 1. Meta-analysis using a random effects model showed a decrease in hospital mortality (OR 0.77 [95% CI 0.60–0.97]; p = 0.00; I2 = 91%) in high-volume hospitals treating SAH patients. Sensitivity analysis revealed the relative weight of the 1 low-quality study. Removal of the study with very low quality increased the effect size of the meta-analysis to an OR of 0.68 (95% CI 0.56–0.84; p = 0.00; I2 = 86%). The definition of hospital volume differed among studies. Cutoffs and dichotomizations were used as well as division in quartiles. In 1 study, low volume was defined as 9 or fewer patients yearly, whereas in another it was defined as fewer than 30 patients yearly. Similarly, 1 study defined high volume as more than 20 patients annually, and another defined it as more than 50 patients a year. For comparability between studies, recalculation was done with dichotomized data if available. Cross et al., 2003 (low volume ≤ 18, high volume ≥ 19) and Johnston, 2000 (low volume ≤ 31, high volume ≥ 32) provided core data for recalculation. The overall results of this analysis revealed an OR of 0.85 (95% CI 0.72–0.99; p = 0.00; I2 = 87%). Conclusions Despite the shortcomings of this study, the mortality rate was lower in hospitals with a larger caseload. Limitations of the meta-analysis are the not uniform cutoff values and uncertainty about case mix.

scholarly journals Endovascular Coiling Versus Neurosurgical Clipping for Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis

Cureus ◽  
2019 ◽  
Author(s):  
Syed Ijlal Ahmed ◽  
Gohar Javed ◽  
Syeda Beenish Bareeqa ◽  
Syeda Sana Samar ◽  
Ali Shah ◽  
...  
Keyword(s):  
Systematic Review ◽  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Meta Analysis ◽  
Endovascular Coiling

Associations of Volume and Thyroidectomy Outcomes

2016 ◽  
Vol 155 (1) ◽  
pp. 65-75 ◽  
Author(s):  
Tsung-Jung Liang ◽  
Shiuh-Inn Liu ◽  
King-Tong Mok ◽  
Hon-Yi Shi
Keyword(s):  
Hospital Mortality ◽  
Meta Analysis ◽  
Relevant Literature ◽  
Survival Rates ◽  
High Volume ◽  
Mortality Rates ◽  
Surgeon Volume ◽  
The Mean ◽  
Low Volume ◽  
Mean Cost

Objective This study explored how different hospital volumes and surgeon volumes affect thyroidectomy outcomes in terms of length of stay (LOS), costs, and in-hospital mortality. Data Sources MEDLINE and EMBASE databases. Review Methods This study retrospectively analyzed a cohort of 125,037 thyroidectomy patients treated at Taiwan hospitals from 1996 to 2010. Relationships between hospital/surgeon volume and patient outcomes were retrospectively analyzed by propensity score matching. In conjunction with the retrospective study, a systematic review and meta-analysis of the relevant literature also were performed. Results The mean LOS for all thyroidectomies performed during the study period was 3.3 days, and the mean cost was $1193.5. Both high-volume hospitals and high-volume surgeons were associated with significantly shorter LOS and lower costs compared with their low-volume counterparts ( P < .001). Different volume groups had similar in-hospital mortality rates. The meta-analysis results consistently showed that the benefits of high-volume hospitals/surgeons are reduced LOS and costs. However, low in-hospital mortality rates were associated with high-volume surgeons but not with high-volume hospitals. Conclusions This meta-analysis showed that patients who received thyroidectomies performed by high-volume hospitals and surgeons had shorter LOS and lower costs compared with those treated by low-volume hospitals and surgeons. In addition, in-hospital survival rates were better in patients treated by high-volume surgeons. Further research is needed to define the learning curve for thyroidectomy and to clarify how hospital volume and surgeon volume affect its success rate.

Clinical presentations and outcomes of Takotsubo syndrome in the setting of subarachnoid hemorrhage: A systematic review and meta-analysis

2016 ◽  
Vol 7 (3) ◽  
pp. 236-245 ◽  
Author(s):  
Akram Y Elgendy ◽  
Islam Y Elgendy ◽  
Hend Mansoor ◽  
Ahmed N Mahmoud
Keyword(s):  
Systematic Review ◽  
Subarachnoid Hemorrhage ◽  
Confidence Interval ◽  
Hospital Mortality ◽  
Random Effects ◽  
Odds Ratio ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Takotsubo Syndrome ◽  
Spontaneous Subarachnoid Hemorrhage

Background: Evidence remains inconsistent regarding the incidence and prognosis of Takotsubo syndrome in the setting of subarachnoid hemorrhage. Thus, we aimed to evaluate the clinical presentation and in-hospital mortality of these patients. Methods: A systematic review of the electronic databases was conducted for studies involving patients with spontaneous subarachnoid hemorrhage and concomitant findings of classical Takotsubo syndrome on transthoracic echocardiogram. A meta-analysis was conducted for the primary outcome of in-hospital mortality using the Mantel–Haenszel method for fixed effects and the DerSimonian and Laird method for random effects, with 95% confidence interval and a p-value <0.05 for statistical significance. Results: Ten studies were retrieved with a total of 157 patients presenting with classical Takotsubo syndrome, representing 4.4% of the subarachnoid hemorrhage total population. The overall incidence of in-hospital mortality was 30% in the patients who developed Takotsubo syndrome. Meta-analysis illustrated a significant increase in the odds of in-hospital mortality for the Takotsubo syndrome patients by fixed effects model (odds ratio 2.6, 95% confidence interval 1.16–5.85, p=0.02, I2=39%), with a trend towards increased risk of in-hospital mortality by random effects model (odds ratio 3.00, 95% confidence interval 0.90–9.77, p = 0.07). Conclusions: The incidence of Takotsubo syndrome in patients with spontaneous subarachnoid hemorrhage seems to be high with a trend towards higher risk of in-hospital mortality in those patients. Thus, patients presenting with subarachnoid hemorrhage might benefit from a comprehensive cardiac evaluation upon presentation for early detection and proper triage of this high-risk population.

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

2018 ◽  
Vol 14 (3) ◽  
pp. 282-289 ◽  
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.

scholarly journals Effectiveness comparisons of drug therapies for postoperative aneurysmal subarachnoid hemorrhage patients: network meta‑analysis and systematic review

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wanli Yu ◽  
Yizhou Huang ◽  
Xiaolin Zhang ◽  
Huirong Luo ◽  
Weifu Chen ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Clinical Outcome ◽  
Glasgow Outcome Scale ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Cochrane Library ◽  
Curative Effect ◽  
Clinical Prognosis ◽  
Drug Interventions

Abstract Objective To compare the effectiveness of various drug interventions in improving the clinical outcome of postoperative patients after aneurysmal subarachnoid hemorrhage (aSAH) and assist in determining the drugs of definite curative effect in improving clinical prognosis. Methods Eligible Randomized Controlled Trials (RCTs) were searched in databases of PubMed, EMBASE, and Cochrane Library (inception to Sep 2020). Glasgow Outcome Scale (GOS) score, Extended Glasgow Outcome Scale (GOSE) score or modified Rankin Scale (mRS) score was used as the main outcome measurements to evaluate the efficacy of various drugs in improving the clinical outcomes of postoperative patients with aSAH. The network meta-analysis (NMA) was conducted based on a random-effects model, dichotomous variables were determined by using odds ratio (OR) with 95% confidence interval (CI), and a surface under the cumulative ranking curve (SUCRA) was generated to estimate the ranking probability of comparative effectiveness among different drug therapies. Results From the 493 of initial citation screening, forty-four RCTs (n = 10,626 participants) were eventually included in our analysis. Our NMA results showed that cilostazol (OR = 3.35,95%CI = 1.50,7.51) was the best intervention to improve the clinical outcome of patients (SUCRA = 87.29%, 95%CrI 0.07–0.46). Compared with the placebo group, only two drug interventions [nimodipine (OR = 1.61, 95%CI 1.01,2.57) and cilostazol (OR = 3.35, 95%CI 1.50, 7.51)] achieved significant statistical significance in improving the clinical outcome of patients. Conclusions Both nimodipine and cilostazol have exact curative effect to improve the outcome of postoperative patients with aSAH, and cilostazol may be the best drug to improve the outcome of patients after aSAH operation. Our study provides implications for future studies that, the combination of two or more drugs with relative safety and potential benefits (e.g., nimodipine and cilostazol) may improve the clinical outcome of patients more effectively.

scholarly journals Clinical Efficacy and Safety of Tranexamic Acid in Aneurysmal Subarachnoid Hemorrhage: a Meta-analysis of Randomized Controlled Trials

2021 ◽  
Author(s):  
Tao Liu ◽  
Lingqin Wu ◽  
Renmin Xue ◽  
Huiru Ding
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Adverse Events ◽  
Tranexamic Acid ◽  
Randomized Controlled Trials ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Meta Analysis ◽  
Delayed Cerebral Ischemia ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Randomized Controlled

Abstract Background: Tranexamic acid, as a traditional hemostatic agent, is commonly applied in the treatment or prevention of excessive blood loss. However, the role of tranexamic acid in promoting good clinical outcomes, reducing mortality, and the risk of experiencing adverse events during the therapeutic process of aneurysmal subarachnoid hemorrhage remains unclear.Methods: In strict accordance with the inclusion and exclusion criteria, the Cochrane Library, Embase, Web of Science, and PubMed were retrieved for randomized-controlled trials (from 1980 to 2021). Statistical analysis was performed using STATA 16.0 and RevMan 5.3. In addition, the fixed-effect model (M-H method) and effect size RR (95% CI) were used as a pooled measure to combine the heterogeneous data. We also performed post hoc sensitivity analysis and subgroup analysis to evaluate each outcome with low heterogeneity.Results: Meta-analysis revealed that although tranexamic acid was related to less rebleeding (RR = 0.72; 95% CI 0.59-0.87; P = 0.0008), it might have no effect on good clinical outcome or mortality (RR = 0.98; 95% CI 0.92-1.04; P = 0.51; RR = 1.01; 95% CI 0.88-1.15; P = 0.91). Tranexamic acid was associated with increased hydrocephalus (RR = 1.13; 95% CI 1.02-1.24; P = 0.02), delayed cerebral ischemia (RR = 1.70; 95% CI 1.34-2.16; P < 0.0001) and seizure (RR = 1.46; 95% CI 1.00-2.14; P = 0.05). The incidence of thromboembolic complications was identical in both groups (RR = 0.91; 95% CI 0.63-1.31; P = 0.62), and there were significant drug-related overall adverse events (RR = 1.21; 95% CI 1.11- 1.32; P < 0.0001).Conclusions: These findings indicate that the routine use of TXA is not suggested for patients with aneurysmal subarachnoid hemorrhage.

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