Mortality rates after subarachnoid hemorrhage: variations according to hospital case volume in 18 states

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  • 1 Mallinckrodt Institute of Radiology, Barnes-Jewish Hospital; Department of Neurological Surgery, Washington University, St. Louis, Missouri; Department of Neurology, University of Washington Medical School, Seattle, Washington; and Boston Scientific Corporation, Natick, Massachusetts and Fremont, California
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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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  • 1.

    Bach PB, , Cramer LD, & Schrag D, et al: The influence of hospital volume on survival after resection for lung cancer. N Engl J Med 345:181188, 2001 Bach PB, Cramer LD, Schrag D, et al: The influence of hospital volume on survival after resection for lung cancer. N Engl J Med 345:181–188, 2001

    • Search Google Scholar
    • Export Citation
  • 2.

    Bardach NS, , Zhao S, & Gress DR, et al: Association between subarachnoid hemorrhage outcomes and number of cases treated at California hospitals. Stroke 33:18511856, 2002 Bardach NS, Zhao S, Gress DR, et al: Association between subarachnoid hemorrhage outcomes and number of cases treated at California hospitals. Stroke 33:1851–1856, 2002

    • Search Google Scholar
    • Export Citation
  • 3.

    Birkmeyer JD, , Siewers AE, & Finlayson EV, et al: Hospital volume and surgical mortality in the United States. N Engl J Med 346:11281137, 2002 Birkmeyer JD, Siewers AE, Finlayson EV, et al: Hospital volume and surgical mortality in the United States. N Engl J Med 346:1128–1137, 2002

    • Search Google Scholar
    • Export Citation
  • 4.

    Canto JG, , Every NR, & Magid DJ, et al: The volume of primary angioplasty procedures and survival after acute myocardial infarction. National Registry of Myocardial Infarction 2 Investigators. N Engl J Med 342:15731580, 2000 Canto JG, Every NR, Magid DJ, et al: The volume of primary angioplasty procedures and survival after acute myocardial infarction. National Registry of Myocardial Infarction 2 Investigators. N Engl J Med 342:1573–1580, 2000

    • Search Google Scholar
    • Export Citation
  • 5.

    Cebul RD, , Snow RJ, & Pine R, et al: Indications, outcomes, and provider volumes for carotid endarterectomy. JAMA 279:12821287, 1998 Cebul RD, Snow RJ, Pine R, et al: Indications, outcomes, and provider volumes for carotid endarterectomy. JAMA 279:1282–1287, 1998

    • Search Google Scholar
    • Export Citation
  • 6.

    Choti MA, , Bowman HM, & Pitt HA, et al: Should hepatic resections be performed at high-volume referral centers? J Gastrointest Surg 2:1120, 1998 Choti MA, Bowman HM, Pitt HA, et al: Should hepatic resections be performed at high-volume referral centers? J Gastrointest Surg 2:11–20, 1998

    • Search Google Scholar
    • Export Citation
  • 7.

    Du Mesnil de Rochemont R, , Heindel W, & Wesselmann C, et al: Nontraumatic subarachnoid hemorrhage: value of repeat angiography. Radiology 202:798800, 1997 Du Mesnil de Rochemont R, Heindel W, Wesselmann C, et al: Nontraumatic subarachnoid hemorrhage: value of repeat angiography. Radiology 202:798–800, 1997

    • Search Google Scholar
    • Export Citation
  • 8.

    Glasgow RE, & Mulvihill SJ: Hospital volume influences outcome in patients undergoing pancreatic resection for cancer. West J Med 165:294300, 1996 Glasgow RE, Mulvihill SJ: Hospital volume influences outcome in patients undergoing pancreatic resection for cancer. West J Med 165:294–300, 1996

    • Search Google Scholar
    • Export Citation
  • 9.

    Grumbach K, , Anderson KL, & Brand R, et al: Selective referral to high-volume hospitals: estimating potentially avoidable deaths. JAMA 283:11591166, 2000 Grumbach K, Anderson KL, Brand R, et al: Selective referral to high-volume hospitals: estimating potentially avoidable deaths. JAMA 283:1159–1166, 2000

    • Search Google Scholar
    • Export Citation
  • 10.

    Healthcare Cost and Utilization Project: HCUPnet: A Tool for Identifying, Tracking, Analyzing, and Comparing Statistics on Hospitals at the National, Regional, and State Level. (http://www.ahrq.gov/data/hcup/hcupnet.htm) [Accessed 22 August 2003] Healthcare Cost and Utilization Project: HCUPnet: A Tool for Identifying, Tracking, Analyzing, and Comparing Statistics on Hospitals at the National, Regional, and State Level. (http://www.ahrq.gov/data/hcup/hcupnet.htm) [Accessed 22 August 2003]

    • Search Google Scholar
    • Export Citation
  • 11.

    Imperato PJ, , Nenner RP, & Starr HA, et al: The effects of regionalization on clinical outcomes for a high risk surgical procedure: a study of the Whipple procedure in New York State. Am J Med Qual 11:193197, 1996 Imperato PJ, Nenner RP, Starr HA, et al: The effects of regionalization on clinical outcomes for a high risk surgical procedure: a study of the Whipple procedure in New York State. Am J Med Qual 11:193–197, 1996

    • Search Google Scholar
    • Export Citation
  • 12.

    Johnston SC: Effect of endovascular services and hospital volume on cerebral aneurysm treatment outcomes. Stroke 31:111117, 2000 Johnston SC: Effect of endovascular services and hospital volume on cerebral aneurysm treatment outcomes. Stroke 31:111–117, 2000

    • Search Google Scholar
    • Export Citation
  • 13.

    Johnston SC, , Dudley RA, & Gress DR, et al: Surgical and endovascular treatment of unruptured cerebral aneurysms at university hospitals. Neurology 52:17991805, 1999 Johnston SC, Dudley RA, Gress DR, et al: Surgical and endovascular treatment of unruptured cerebral aneurysms at university hospitals. Neurology 52:1799–1805, 1999

    • Search Google Scholar
    • Export Citation
  • 14.

    Johnston SC, , Selvin S, & Gress DR: The burdens, trends, and demographics of mortality from subarachnoid hemorrhage. Neurology 50:14131418, 1998 Johnston SC, Selvin S, Gress DR: The burdens, trends, and demographics of mortality from subarachnoid hemorrhage. Neurology 50:1413–1418, 1998

    • Search Google Scholar
    • Export Citation
  • 15.

    Johnston SC, , Zhao S, & Dudley RA, et al: Treatment of unruptured cerebral aneurysms in California. Stroke 32:597605, 2001 Johnston SC, Zhao S, Dudley RA, et al: Treatment of unruptured cerebral aneurysms in California. Stroke 32:597–605, 2001

    • Search Google Scholar
    • Export Citation
  • 16.

    Jollis JG, , Peterson ED, & DeLong ER, et al: The relation between the volume of coronary angioplasty procedures at hospitals treating Medicare beneficiaries and short-term mortality. N Engl J Med 331:16251629, 1994 Jollis JG, Peterson ED, DeLong ER, et al: The relation between the volume of coronary angioplasty procedures at hospitals treating Medicare beneficiaries and short-term mortality. N Engl J Med 331:1625–1629, 1994

    • Search Google Scholar
    • Export Citation
  • 17.

    Karp HR, , Flanders WD, & Shipp CC, et al: Carotid endarterectomy among Medicare beneficiaries: a statewide evaluation of appropriateness and outcome. Stroke 29:4652, 1998 Karp HR, Flanders WD, Shipp CC, et al: Carotid endarterectomy among Medicare beneficiaries: a statewide evaluation of appropriateness and outcome. Stroke 29:46–52, 1998

    • Search Google Scholar
    • Export Citation
  • 18.

    Lavernia CJ, & Guzman JF: Relationship of surgical volume to short-term mortality, morbidity, and hospital charges in arthroplasty. J Arthroplasty 10:133140, 1995 Lavernia CJ, Guzman JF: Relationship of surgical volume to short-term mortality, morbidity, and hospital charges in arthroplasty. J Arthroplasty 10:133–140, 1995

    • Search Google Scholar
    • Export Citation
  • 19.

    Luft HS, , Bunker JP, & Enthoven AC: Should operations be regionalized? The empirical relation between surgical volume and mortality. N Engl J Med 301:13641369, 1979 Luft HS, Bunker JP, Enthoven AC: Should operations be regionalized? The empirical relation between surgical volume and mortality. N Engl J Med 301:1364–1369, 1979

    • Search Google Scholar
    • Export Citation
  • 20.

    Mount LA: Practical applications, in Sahs AL, , Perret GE, & Locksley HB, et al (eds): Intracranial Aneurysms and Subarachnoid Hemorrhage: A Cooperative Study. Philadelphia: Lippincott, 1969, pp 276280 Mount LA: Practical applications, in Sahs AL, Perret GE, Locksley HB, et al (eds): Intracranial Aneurysms and Subarachnoid Hemorrhage: A Cooperative Study. Philadelphia: Lippincott, 1969, pp 276–280

    • Search Google Scholar
    • Export Citation
  • 21.

    Pedersen HK, , Bakke SJ, & Hald JK, et al: CTA in patients with acute subarachnoid haemorrhage. A comparative study with selective, digital angiography and blinded, independent review. Acta Radiol 42:4349, 2001 Pedersen HK, Bakke SJ, Hald JK, et al: CTA in patients with acute subarachnoid haemorrhage. A comparative study with selective, digital angiography and blinded, independent review. Acta Radiol 42:43–49, 2001

    • Search Google Scholar
    • Export Citation
  • 22.

    Popovic JR: 1999 National Hospital Discharge Survey: annual summary with detailed diagnosis and procedure data. Vital Health Stat 151:iv, 1–206, 2001 Popovic JR: 1999 National Hospital Discharge Survey: annual summary with detailed diagnosis and procedure data. Vital Health Stat 151:i–v, 1–206, 2001

    • Search Google Scholar
    • Export Citation
  • 23.

    Prentice RL: Correlated binary regression with covariates specific to each binary observation. Biometrics 44:10331048, 1988 Prentice RL: Correlated binary regression with covariates specific to each binary observation. Biometrics 44:1033–1048, 1988

    • Search Google Scholar
    • Export Citation
  • 24.

    Shook TL, , Sun GW, & Burstein S, et al: Comparison of percutaneous transluminal coronary angioplasty outcome and hospital costs for low-volume and high-volume operators. Am J Cardiol 77:331336, 1996 Shook TL, Sun GW, Burstein S, et al: Comparison of percutaneous transluminal coronary angioplasty outcome and hospital costs for low-volume and high-volume operators. Am J Cardiol 77:331–336, 1996

    • Search Google Scholar
    • Export Citation
  • 25.

    Showstack JA, , Rosenfield KE, & Garnick DW, et al: Association of volume with outcome of coronary artery bypass graft surgery. Scheduled vs. nonscheduled operations. JAMA 257:785789, 1987 Showstack JA, Rosenfield KE, Garnick DW, et al: Association of volume with outcome of coronary artery bypass graft surgery. Scheduled vs. nonscheduled operations. JAMA 257:785–789, 1987

    • Search Google Scholar
    • Export Citation
  • 26.

    Solomon RA, , Mayer SA, & Tarmey JJ: Relationship between the volume of craniotomies for cerebral aneurysm performed at New York state hospitals and in-hospital mortality. Stroke 27:1317, 1996 Solomon RA, Mayer SA, Tarmey JJ: Relationship between the volume of craniotomies for cerebral aneurysm performed at New York state hospitals and in-hospital mortality. Stroke 27:13–17, 1996

    • Search Google Scholar
    • Export Citation
  • 27.

    Suzuki S, , Kayama T, & Sakurai Y, et al: Subarachnoid hemorrhage of unknown cause. Neurosurgery 21:310313, 1987 Suzuki S, Kayama T, Sakurai Y, et al: Subarachnoid hemorrhage of unknown cause. Neurosurgery 21:310–313, 1987

    • Search Google Scholar
    • Export Citation
  • 28.

    Taylor CL, , Yuan Z, & Selman WR, et al: Mortality rates, hospital lengths of stay, and the cost of treating subarachnoid hemorrhage in older patients: institutional and geographic differences. J Neurosurg 86:583588, 1997 Taylor CL, Yuan Z, Selman WR, et al: Mortality rates, hospital lengths of stay, and the cost of treating subarachnoid hemorrhage in older patients: institutional and geographic differences. J Neurosurg 86:583–588, 1997

    • Search Google Scholar
    • Export Citation
  • 29.

    Van Gijn J, & Rinkel GJ: Subarachnoid hemorrhage: diagnosis, causes and management. Brain 124:249278, 2001 Van Gijn J, Rinkel GJ: Subarachnoid hemorrhage: diagnosis, causes and management. Brain 124:249–278, 2001

    • Search Google Scholar
    • Export Citation
  • 30.

    Wennberg DE, , Lucas FL, & Birkmeyer JD, et al: Variation in carotid endarterectomy mortality in the Medicare population: trial hospitals, volume, and patient characteristics. JAMA 279:12781281, 1998 Wennberg DE, Lucas FL, Birkmeyer JD, et al: Variation in carotid endarterectomy mortality in the Medicare population: trial hospitals, volume, and patient characteristics. JAMA 279:1278–1281, 1998

    • Search Google Scholar
    • Export Citation
  • 31.

    Winn HR, , Newell DW, & Mayberg MR, et al: Early surgical management of poor-grade patients with intracranial aneurysms. Clin Neurosurg 36:289298, 1990 Winn HR, Newell DW, Mayberg MR, et al: Early surgical management of poor-grade patients with intracranial aneurysms. Clin Neurosurg 36:289–298, 1990

    • Search Google Scholar
    • Export Citation
  • 32.

    Zentner J, , Solymosi L, & Lorenz M: Subarachnoid hemorrhage of unknown etiology. Neurol Res 18:220226, 1996 Zentner J, Solymosi L, Lorenz M: Subarachnoid hemorrhage of unknown etiology. Neurol Res 18:220–226, 1996

    • Search Google Scholar
    • Export Citation

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